A scientific statement from the American Heart Association (AHA) shows that addressing cardiovascular health earlier in life can reduce the risk of stroke and prevent earlier onset or progression of later-life cognitive impairment. These results were reported by Fernando D. Testai, MD, PhD, chair of the AHA scientific statement, and colleagues, in a manuscript published online in Stroke. Heart and brain health work together to provide overall bodily health and maintenance. Because of this link, vascular risk factors and cardiovascular diseases have influence on brain structure and function. This AHA statement addressed mechanisms that link cognitive impairment to three common cardiovascular diseases: heart failure (HF), atrial fibrillation (AF) and coronary heart disease (CHD). Authors of this statement used a PubMed search to find papers analyzing the relationship between those three common cardiovascular diseases and cognitive impairment. HF is a significant public health burden and is associated with cognitive decline in older adults. A large meta-analysis showed that 43% of HF patients also experienced cognitive decline. Patients with left ventricular systolic and diastolic dysfunction had increased hyperintensity burden. Patients with HF with reduced ejection fraction (HFrEF) are at increased risk for stroke and decreased tissue perfusion, which are also associated with cognitive decline. Improving stroke volume and outcomes in HF/HFpEF patients may improve brain and cognitive health. The most common clinical arrhythmia in the adult population is AF; about 15.9 million people in the U.S. are expected to have AF by 2050. A large meta-analysis confirmed that AF was associated with a 39% increased risk of cognitive impairment. The analysis also showed that women with AF may be more susceptible to cognitive impairment compared with men. Risk factors for AF and dementia overlap: hypertension, smoking, HF, vascular disease, etc. Inflammation may also be associated with AF-related brain injury; both AF and Alzheimer’s Disease have systemic inflammation profiles. Reducing the burden of AF by rhythm control or catheter ablation may decrease dementia risk, the statement's authors wrote. In a systematic review of over 1 million participants, those with a history of CHD had a 1.27 (95% confidence interval [CI]=1.07-1.50) relative risk of dementia, compared to those without CHD. Cognitive decline in this patient population is also associated with myocardial infarction (MI), with rates ranging from 2-50% of patients. Coronary microvascular dysfunction is also common in patients with CHD and is associated with reduced cerebral blood flow and small vessel disease. Treating these cardiovascular disorders may help prevent cognitive decline. Many people have undiagnosed or partially controlled cardiovascular disease. Factors like limited healthcare access, delayed treatment initiation and negative misconceptions around unhealthful behaviors — such as a sedentary lifestyle, alcohol consumption or an unhealthy diet — may contribute to this treatment gap. “The pathogenesis of vascular injury and neurodegeneration, once considered distinct disease processes, are intimately intertwined,” the authors wrote. Source: Testai FD, Gorelick, PB, Chuang P, et al. Cardiac contributions to brain health: A scientific statement from the American Heart Association. Stroke. 2024 Oct 10. (Article in press) Image Credit: Katie Chizhevskaya – stock.adobe.com