A recent scientific statement from the American Heart Association highlights that improving cardiovascular health earlier in life could potentially lower stroke risk and aid in maintaining mental clarity as people age.
The statement, titled “Cardiac Contributions to Brain Health,” published in the journal Stroke, associates three prevalent cardiovascular diseases in adults—heart failure, atrial fibrillation, and coronary heart disease—with cognitive decline and a heightened risk of dementia.
This statement reviews recent studies that explore how cardiovascular health relates to brain health, particularly regarding cognitive issues or dysfunction. It underscores the significant link between heart health and brain function and its importance for overall well-being.
“Both stroke and cognitive decline are serious, enduring conditions that substantially affect individuals and society,” stated Dr. Fernando D. Testai, the chair of the writing group and a professor at the University of Illinois College of Medicine. “Taking steps to manage heart health from an early age is essential in preventing cardiovascular diseases, protecting brain health, and mitigating cognitive decline in later years.”
Dr. Testai further noted, “While dementia is often viewed as an unavoidable ailment, evidence suggests that a healthy lifestyle and early management of vascular risks can help maintain normal brain function and lessen the effects of Alzheimer’s and similar dementias.”
Heart Failure
Heart failure is a significant health concern, linked to factors such as high blood pressure, obesity, and Type 2 diabetes. It can lead to cognitive impairment, impacting everyday activities like self-care and medication adherence, especially among older adults. Research indicates that nearly 50% of those with heart failure show some form of cognitive impairment affecting language, memory, or executive functions, with more severe heart failure correlating with worse cognitive issues.
The impact of heart failure on the brain can occur through several pathways. Decreased blood flow may result in mini-strokes or unnoticed brain injuries. Additionally, ongoing inflammation and neurohormonal changes can further harm the brain. Many individuals with heart failure also struggle with obesity and sleep disorders, both of which are tied to cognitive dysfunction. Brain alterations, such as reductions in gray matter or white matter damage, often accompany heart failure, affecting overall brain performance. Newer studies suggest that genetic factors may link heart failure with neurodegenerative diseases like Alzheimer’s.
For patients experiencing severe heart failure, it is crucial to conduct cognitive assessments before any surgical procedures, as there is a heightened risk of stroke, a common cause of cognitive decline.
Atrial Fibrillation
Atrial fibrillation is the most prevalent heart rhythm disorder among adults, and its occurrence in the U.S. is expected to rise from 2.7 million cases in 2020 to almost 16 million by 2050. While atrial fibrillation is well-known for its link to stroke, its connection to cognitive decline requires further investigation. A notable meta-analysis revealed that atrial fibrillation raises the risk of cognitive impairment by 39%.
Common risk factors that connect atrial fibrillation and dementia include high blood pressure, Type 2 diabetes, heart failure, smoking, vascular diseases, sleep apnea, and older age—all contributing to functional and structural brain changes that lead to cognitive decline. Stroke, a significant predictor of cognitive impairment, is directly linked to atrial fibrillation. Moreover, microhemorrhages, or small brain bleeds, are more likely to occur in individuals with atrial fibrillation and are associated with cognitive difficulties.
The reduced blood flow to vital brain regions due to atrial fibrillation (similar to heart failure effects) may impair cognitive functions. Both atrial fibrillation and Alzheimer’s are linked to systemic inflammation, with inflammatory markers increasing the risk of blood clots and brain injuries. Although further research is needed to understand this relationship better, it highlights the intricate connection between the nervous system and cardiovascular health.
Effective management of atrial fibrillation, incorporating anti-clotting drugs, rhythm stabilization, or catheter-based procedures, may help lessen cognitive decline risks. Ongoing research is investigating whether restoring normal heart rhythm through catheter ablation could be more effective for cognitive health than just medication.
Coronary Heart Disease
Coronary heart disease poses a significant risk for dementia and cognitive impairment. A comprehensive review involving over a million adults found that individuals with heart disease have a 27% increased likelihood of developing dementia compared to those without heart conditions. Up to half of heart attack survivors may experience a decline in cognitive abilities. Data from several large studies indicate that heart attacks can lead to a more pronounced reduction in cognitive functions such as memory and executive skills. Additionally, increased calcium deposits in the arteries are correlated with a heightened risk of dementia.
Various mechanisms allow coronary heart disease to impair cognitive function. Common risk factors, including high blood pressure and Type 2 diabetes, cause inflammation that impacts the blood-brain barrier and restricts cerebral blood flow, leading to cognitive issues and dementia. There is also a connection between heart disease and small vessel disorders in the brain, which decreases blood flow and boosts cognitive decline risks. Such problems are frequently observed in Alzheimer’s patients, illustrating the close association between vascular damage and brain degeneration. Moreover, genetic predispositions that increase heart disease likelihood might also facilitate cognitive atrophy.
Addressing vascular risk factors may aid in preserving cognitive function, though the specific effects on coronary heart disease patients remain uncertain. Intensive treatment for high blood pressure has shown potential in reducing mild cognitive impairment, albeit not dementia. Other studies indicate that managing cardiovascular risks through lifestyle changes, such as improved diet and increased physical activity, may support cognitive health.
Dr. Testai remarked, “While new treatments for Alzheimer’s disease are being developed, the medical community acknowledges that prevention is preferable to treatment. More investigation is necessary to clarify how cardiovascular management can enhance brain health. Additionally, understanding how factors like gender, race, and ethnicity influence the relationship between heart and brain health is vital.”
“Healthcare professionals should adopt a holistic approach when treating patients, focusing on heart health throughout life. It is essential to promote cardiovascular wellness early on with resources supporting healthier lifestyles and to monitor heart health using tools like the American Heart Association’s Life’s Essential 8, as doing so can lower the risk of cognitive decline.”
This statement was crafted by a volunteer writing team representing various councils within the American Heart Association. Their goal was to help raise awareness about cardiovascular diseases and stroke and facilitate more informed healthcare choices. Scientific statements detail current knowledge on a topic while identifying areas warranting further research. Although they guide the development of clinical guidelines, they do not provide treatment recommendations. The guidelines present the Association’s established clinical practice directives.
Co-authors of the statement include Dr. Philip B. Gorelick, Dr. Pei-Ying Chuang, Dr. Xing Dai, Dr. Karen L. Furie, Dr. Rebecca F. Gottesman, Dr. Jose C. Iturrizaga, Dr. Ronald M. Lazar, Dr. Andrea M. Russo, Dr. Sudha Seshadri, and Dr. Elaine Y. Wan. Details on author disclosures can be found in the manuscript.
