• A new statement from the American Heart Association emphasizes the link between heart health and brain health.
• Three common cardiovascular diseases — heart failure, atrial fibrillation, and coronary heart disease — have shown to significantly raise the risk of cognitive impairment and dementia.
• Taking measures to protect your heart health and prevent disease should be initiated early in life, even during childhood.

If you want a healthy brain later in life, take care of your heart today — or, better yet, as early in your life as possible.

That’s the message of a new scientific statement from the American Heart Association (AHA) addressing the complex relationship between heart disease and cognitive decline.

According to the authors, the brain and heart should not be considered unrelated organ systems, but reciprocal, interdependent, systems — especially as far as disease pathogenesis is concerned.

“The fates of the heart and brain are intricately intertwined,” said Fernando D. Testai, MD, PhD, Chair of the statement writing group, professor of neurology and rehabilitation and vascular neurology fellowship director at the University of Illinois College of Medicine and stroke medical director at the University of Illinois Hospital in Chicago.

“The interconnection between the brain and the heart has long been recognized. For instance, heart disease can impact the brain by increasing the risk of stroke or reducing cardiac output, as occurs in patients with heart failure. Conversely, stroke in specific neuroanatomic areas can lead to cardiac abnormalities, such as arrhythmias.” he told Healthline.

The AHA statement expands upon the myriad ways in which three of the most common cardiovascular diseases — heart failure, atrial fibrillation, and coronary heart disease — impact cognitive decline and dementia. It also addresses prevention, with a strong emphasis on managing heart health from an early age to limit potential downstream effects on brain health.

Understanding the heart-brain connection

Nearly half of adults in the United States (130 million people) have some form of cardiovascular disease.

That’s a serious enough issue on its own, but doctors have increasingly found evidence that cardiovascular disease also affects brain health.

According to the statement, around 43% of people with heart failure experience some form of cognitive impairment, which could have a detrimental impact on:

• attention
• language
• verbal fluency
• processing speed
• working memory
• executive functioning

Meanwhile, evidence also indicates that individuals with atrial fibrillation have a 39% increased risk of cognitive problems.

Coronary heart disease is responsible for a 27% higher risk of developing dementia, and after a heart attack, up to 50% of patients may experience cognitive decline.

Although the mechanisms for why heart health affects cognition are complex and not entirely understood, the AHA statement lays out how some common cardiovascular diseases contribute to them.

For example, cardiovascular disease may affect how blood is being pumped to the rest of the body, including the brain. Poor blood circulation in the brain can disrupt brain structure and function.

Researchers believe that numerous factors may play a role in the heart-brain connection, including:

• chronic inflammation
• oxidative stress
• genetic predisposition

“There are striking similarities in the inflammatory responses observed in patients with heart conditions and those experiencing cognitive decline. This suggests that damage to one organ, like the heart, may trigger an immune response that affects another, such as the brain,” Testai said.

Testai noted evidence of other mechanisms involved. The blood biomarker beta-amyloid, which is associated with Alzheimer’s disease, has been detected in cardiac tissue, where it is associated with cardiac dysfunction. The presence of beta-amyloid in both the heart and brain suggest a deep connection between the two systems.

According to Abinash Achrekar, MD, MPH, executive vice chair of medicine at University of New Mexico, despite the unique mechanisms of different forms of cardiovascular disease, they all pose significant downstream dangers to the brain and other systems. Achrekar wasn’t involved in the study.

“Each of these disease processes, congestive heart failure, atrial fibrillation, and coronary artery disease, they’re all slightly different, but they all have consequences throughout the body,” Achrekar told Healthline.

Prioritizing heart health can promote brain health

The AHA statement includes recommendations for protecting heart and brain health.

“It’s really nice to see a scientific statement that mirrors what we see clinically,” Archrekar said. “This statement really gives a good idea of the possible pathogenesis for how these diseases are affecting cognitive function,” he noted.

Abha Khandelwal, MD, a cardiologist and associate professor of medicine at Stanford Medicine, not involved in the study, told Healthline that physicians should always counsel patients about managing cardiovascular risk factors. “That’s been the cornerstone of our recommendations,” Khandelwal said.

That means understanding your risk factors and preventing or treating conditions such as:

• high cholesterol
• hypertension
• obesity

Lifestyle factors, including diet, exercise, sufficient sleep, and reducing stress are paramount to heart disease prevention.

The statement also emphasizes starting prevention well before adulthood.

“This requires adopting healthy habits early in life to minimize the risk of developing risk factors (such as hypertension) that will result in cardiac disease and cognitive decline,” Testai said.

“Given that early development is a critical period, efforts to promote optimal brain health and reduce the risk of cardiovascular diseases should begin in the prenatal stage.”

The earlier you start prioritizing your heart health, the better your chances of preventing heart disease and cognitive decline down the road. Here’s what heart prevention methods over the course of a lifespan could look like:

• Childhood: Testing for and discussing genetic factors that might predispose you to heart disease or dementia; staying physically active, and eating a healthy diet.
• Early adulthood: Building heart healthy habits, like diet and exercise, and identifying and preventing risk factors like hypertension and obesity.
• Midlife: Treating specific symptomatic cardiovascular risk factors
• Older adulthood: Diagnosing and treating cerebrovascular risk factors.

“As a community, I really strongly believe our focus needs to be in early life and childhood,” Khandelwal said.

“There’s a significant proportion of our children who [have obesity], who are not getting enough exercise, and are not eating a healthy diet. It takes a lot of money and resources to start intervention so early, But I think that’s where we’ll start to see a true impact,” she concluded.

Takeaway

A new statement from the American Heart Association highlights the importance of heart health as a risk factor for cognitive decline.

Common forms of heart disease including heart failure, atrial fibrillation, and coronary heart disease have all been shown to significantly increase risk for cognitive impairment and dementia.

Starting prevention of heart disease early in life, even prior to adulthood, is even more important in light of the potential downstream effects on brain health.