The AHA explores the links between heart and brain

L’American Heart Association (AHA) published a scientific analysis of the links between heart failure (HF), atrial fibrillation (AF), coronary heart disease and increased risk of cognitive impairment and dementia.

Inextricable link between heart health and brain health

The AHA’s work includes a review of the literature and provides compelling evidence of the inextricable link between heart health and brain health, which investigators say underscores the benefit of early intervention.

The cumulative data “confirm that trajectories of heart health and brain health are inextricably linked to modifiable and non-modifiable factors,” the authors write.

According to the investigators, the results reinforce the message that addressing cardiovascular health early in life could stop the onset or progression of cognitive impairment in the longer term.

And the sooner this is done, the better, comments the Dr Fernando D. Testaiprofessor of neurology and chief of vascular neurology, department of neurology and rehabilitation, University of Illinois, Chicago, with Medscape Medical News.

The scientific opinion was published online on October 10 in the revue Stroke.

Filling research gaps

It is well known that there is a bidirectional relationship between heart function and brain function. For example, HF can cause decreased blood flow that can damage the brain, and stroke in certain areas of the brain can affect the heart.

However, this knowledge is only part of the puzzle and cannot fully explain how cardiovascular disease influences cognition, Dr. Testai said.

“What we are trying to do here is to go further and describe other connections between the heart and the brain,” he stressed.

Investigators performed an extensive search of PubMed for HF, AF, and coronary heart disease. The researchers detailed the frequency of each pathology, the mechanisms by which they could cause cognitive disorders and the prospects for prevention and treatment to preserve brain health.

A recurring theme in the article is the role of inflammation. Data shows that there are “remarkable similarities in the inflammatory response that occurs” with both heart disease and cognitive decline, Dr. Testai said.

Another potential common mechanism is related to biomarkers, particularly amyloid, which is strongly linked to Alzheimer’s disease.

“Some studies show that amyloid may also be present in the heart, particularly in patients with reduced ejection fraction,” Dr. Testai said.

The link between the two organs “begins at conception”

The authors collected a significant amount of evidence-based data showing that vascular risk factors, such as hypertension and diabetes, “can change the way the brain processes and clears amyloid,” added Dr. Tested.

The article also provides a compilation of evidence-based data regarding shared genetic predispositions with respect to heart and brain disorders.

“We noticed that certain genetic signatures historically associated with heart disease also appear to be correlated with structural changes in the brain. This means that ultimately some patients may be born with a genetic predisposition to developing both conditions,” Dr. Testai said.

This indicates that the connection between the two organs “starts at conception” and highlights the importance of adopting healthy lifestyle habits as soon as possible, he added.

Concept of increased “resilience”

“This means you can avoid bad habits that ultimately lead to high blood pressure, diabetes and cholesterol, which ultimately lead to heart disease, which ultimately leads to stroke, which ultimately leads to heart disease. cognitive decline,” emphasizes Dr. Testai.

However, cardiovascular health is about more than just having good genes and following a healthy lifestyle. It’s not clear, for example, why some people who should be predisposed to developing heart disease don’t develop it, what Dr. Testai calls increased “resilience.”

For example, Hispanic or Latino patients, who have relatively poor cardiovascular risk factor profiles, appear less likely to develop heart disease.

Further research is needed

Although genetics may partly explain the paradox, Dr. Testai believes that other protective factors are at play, including strong social support networks.

Dr. Testai referenced the AHA’s “Life’s Essential 8,” the eight components of cardiovascular health. These include a healthy diet, physical activity, avoiding tobacco, healthy sleep, controlled weight, blood lipid and blood glucose levels in the standards and balanced blood pressure.

More evidence-based data is needed to show that effective management of heart disease positively affects cognition. Currently, cognitive measures are rarely included in studies examining various treatments for heart disease, Dr. Testai lamented.

“There should probably be an effort to include brain health data in some cardiac publications to ensure that we can also measure whether intervening in the heart results in a benefit to the brain,” he said .

Further research is also needed to determine whether immunomodulation has a beneficial effect on cognitive trajectory, the statement’s authors noted.

In terms of limitations, the AHA task force notes that the interpretation and generalizability of the studies described in their work are confounded by disparate methodologies, including small sample sizes, cross-sectional designs, and underrepresentation. individuals of black and Hispanic ethnic origin.

“An important step”

The Dre Natalia S. Rostdirector of the stroke division at Massachusetts General Hospital and professor of neurology at Harvard Medical School in Boston, told Medscape Medical News that this article “is an important step” in terms of gathering relevant information on the subject of heart-brain health.

She praised the authors’ work in collecting evidence-based data on risk factors for AF, HF and CHD, which is “the controllable part of the puzzle”.

The findings help reinforce the message that controlling vascular risk factors contributes to brain health, Natalia Rost said.

But brain health is “much more complex than simple vascular health,” she stressed. It includes other elements such as absence of epilepsy, migraine, traumatic brain injury and adult learning disorders.

This article was translated from Medscape.com using several editorial tools, including AI, in the process. The content was reviewed by the editorial staff before publication.