Heart failure, atrial fibrillation, and coronary heart disease are associated with cognitive impairment

Highlights of the statement:

• Previous studies have found that 14 to 81 percent of heart failure patients experience some degree of cognitive impairment that affects language, memory, or executive function.
• Evidence also shows that people with atrial fibrillation have a 39% increased risk of memory and thinking problems. Adults with heart disease have a 27% higher risk of developing dementia. And up to 50% of people experience cognitive decline after a heart attack.
• Managing heart health from an early age is important not only to prevent heart disease, but also to protect brain health and reduce the risk of cognitive impairment later in life.

Embargoed until Thursday, October 10, 2024 at 4:00 a.m. Central Time/5:00 a.m. Eastern Time

DALLAS, Oct. 10, 2024 — Three common cardiovascular diseases in adults: heart failure, atrial fibrillation, and coronary heart disease, according to a new scientific statement, “The Heart's Contribution to Brain Health.” It was found to be associated with cognitive impairment and increased risk of dementia. An American Heart Association paper published today in the Journal of the American Heart Association, stroke.

This scientific statement reviews the latest research investigating the relationship between cardiovascular health and the heart. brain healthincluding cognitive impairment or neuropsychological dysfunction. This statement emphasizes the interconnectedness of the brain and heart and how important this relationship is to overall health.

“Stroke and cognitive decline, the main determinants of brain health, are chronic and disabling conditions with dramatic effects at the individual and societal levels,” said Fernando D., chair of the statement development group.・Dr. Testai said. Mr. FAHA is Professor of Neurology and Rehabilitation and Director of the Vascular Neurology Fellowship at the University of Illinois College of Medicine and Chief of Stroke Medicine at the University of Illinois Hospital in Chicago. “Managing heart health from an early age is important to prevent cardiovascular disease and heart events, protect brain health, and reduce the risk of cognitive decline in later life.”

Dr Testai added: “Dementia is generally thought of as an incurable disease that cannot be prevented. However, adopting a healthy lifestyle and identifying and treating vascular risk factors early can improve normal functioning. Evidence shows it may help preserve brain function and reduce the burden of Alzheimer's disease and other related dementias.”

heart failure

heart failure This is a significant public health problem with underlying causes such as high blood pressure, obesity, and type 2 diabetes. Heart failure is associated with cognitive impairment, which affects tasks such as self-care and medication management, especially in older adults. A meta-analysis of past studies found that nearly 50% of heart failure patients experience some type of cognitive impairment that can affect language, memory, and/or executive function. Patients with more severe types of heart failure tend to have higher rates of cognitive impairment.

Heart failure can cause brain damage in a variety of ways. Reduced blood flow can cause mild strokes and silent brain damage. Chronic inflammation and activation of neurohormones that work to maintain the brain's environment can also contribute to brain damage. Obesity and sleep-disordered breathing are common symptoms in patients with heart failure and are also associated with cognitive dysfunction. Brain changes such as decreased gray matter volume and white matter damage are common in heart failure and contribute to decreased brain function. Emerging evidence also indicates that patients with heart failure and neurodegenerative diseases such as Alzheimer's disease may share genetic mutations.

For patients with severe heart failure, cognitive screening is recommended before surgical intervention because of the increased risk of stroke. Stroke is known to be one of the most common causes of cognitive decline.

atrial fibrillation

atrial fibrillation Atrial fibrillation is the most common heart rhythm disorder in adults, and its prevalence across the United States is projected to increase from 2.7 million people in 2020 to nearly 16 million people by 2050. The link between atrial fibrillation and stroke is well known;The link between atrial fibrillation and stroke is well known. Further research is needed on fibrillation and cognitive decline. A large meta-analysis found that atrial fibrillation increased the risk of cognitive impairment by 39%.

Common risk factors for atrial fibrillation and dementia include high blood pressure, type 2 diabetes, heart failure, smoking, vascular disease, sleep-disordered breathing, and older age. These factors cause structural and functional changes in the brain, leading to a decline in cognitive function. Stroke, a major predictor of cognitive impairment, has a direct relationship with atrial fibrillation. Small brain bleeds, or microbleeds, are also common in patients with atrial fibrillation and are associated with decreased cognitive function.

The reduced cardiac output associated with atrial fibrillation (similar to heart failure) can impair blood flow to key areas of the brain responsible for cognitive function. Both atrial fibrillation and Alzheimer's disease are associated with systemic inflammation, and inflammatory biomarkers are associated with increased risk of blood clots and brain damage. Although further research is needed to explore this relationship, this observation illustrates the complex interaction between the nervous and cardiovascular systems.

Effective treatment of atrial fibrillation, such as the use of anticoagulants, rhythm control, or catheter ablation procedures, may reduce the risk of cognitive decline. Ongoing research is investigating whether restoring a regular heart rhythm through catheter ablation reduces cognitive impairment compared to drug therapy alone.

coronary heart disease

coronary heart disease The risk of dementia and cognitive impairment is significantly increased. A large systematic review of more than 1 million adults shows that people with heart disease have a 27% higher risk of developing dementia than people without heart disease. After a heart attack, up to 50% of people experience a loss of brain function. Data from multiple large studies shows that heart attacks are associated with a rapid decline in cognitive functions such as memory and executive function. Elevated levels of calcium buildup in the arteries are also associated with an increased risk of developing dementia.

Coronary heart disease can negatively impact brain function through various mechanisms. Common risk factors such as high blood pressure and type 2 diabetes cause inflammation that affects the blood-brain barrier, reducing blood flow to the brain and leading to cognitive decline and dementia. Heart disease is also associated with small vessel disease in the brain and decreased cerebral blood flow, resulting in cognitive impairment. These problems are also seen in patients with Alzheimer's disease, and a close link between vascular damage and brain degeneration has been shown. In addition, genetic factors that increase the risk of heart disease may also contribute to brain atrophy and cognitive decline.

Improving vascular risk factors may preserve cognitive performance, but the specific effects in patients with coronary heart disease are not fully established. Intensive blood pressure treatment has shown promise in reducing mild cognitive impairment but is ineffective against dementia. Other research suggests that managing cardiovascular risk factors through lifestyle interventions such as diet and exercise may help maintain cognitive health.

“New drugs are being developed that may potentially treat Alzheimer's disease, but the medical community is well aware that prevention is better than cure,” Testai said. Further research is needed to confirm and outline how cardiovascular care can improve brain health. Additionally, further research is needed to understand how gender, race, and ethnicity influence the brain-heart relationship. ”

“Health care professionals need to approach patients in a holistic manner, using approaches to improve heart health throughout the lifespan. It's important to promote heart health early on, and it's important to monitor and manage your heart health through resources like the Institute. necessities of life 8 Important for reducing the risk of cognitive impairment. ”

This scientific statement was prepared by a volunteer writing group on behalf of the Stroke Council of the American Heart Association. Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Council on Cardiovascular and Stroke Nursing. and the Hypertension Council. American Heart Association scientific statements help raise awareness about cardiovascular disease and stroke issues and promote informed medical decisions. A scientific statement outlines what is currently known about a topic and areas where additional research is needed. Scientific statements serve to create guidelines, but do not recommend treatments. American Heart Association guidelines provide the association's official clinical practice recommendations.

Co-authors are Vice Chair Philip B. Gorelick, MD, MPH, FAHA; Pei-Ying Chuang, Ph.D., EMBA, MSN, RN. Shin Dai, MD, Karen L. Furey, MD, FAHA; Rebecca F. Gottsman, MD, FAHA; Jose C. Iturrizaga, MD, FAHA; Ronald M. Lazar, MD, FAHA; Andrea M. Russo, MD , FAHA. Sudha Seshadri, MD, and Elaine Y. Wang, MD, FAHA. Author disclosure information is provided in the manuscript.

The association is primarily funded by individuals. Foundations and corporations (including pharmaceuticals, device manufacturers, and other companies) also make contributions, which help fund specific programs and events for the association. The Society has strict policies in place to ensure that these relationships do not influence scientific content. Revenues from pharmaceutical companies, biotechnology companies, device manufacturers, health insurance companies, and overall financial information for the association are available. here.

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About the American Heart Association

The American Heart Association works tirelessly to help the world live longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with thousands of organizations and the power of millions of volunteers, we fund innovative research, advocate for public health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for a century. In 2024, our 100th anniversary, we celebrate 100 years of rich history and achievements. As we move into two centuries of bold discoveries and impact, our vision is to advance health and hope for everyone, everywhere. connect with us at heart.org, facebook, × Or call 1-800-AHA-USA1.

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