COMMENTARY

Heart Health and Cognition: The Link Strengthens

JoAnn E. Manson, MD, DrPH

Disclosures

June 01, 2017

Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I'd like to talk with you about the increasing evidence for a link between heart health and cognition. We've known for a long time that what's good for the heart is good for the brain, and that about 50% of cognitive decline (dementia) is related to vascular disease—either mini-strokes or the interrelationship between vascular disease and Alzheimer's or other pathology. But now there's more direct evidence for a link.

In a recent report in JAMA[1] from the ARIC (Atherosclerosis Risk in Communities) study, there was very strong evidence for a relationship between midlife cardiovascular risk factor status and the odds of having amyloid deposition in the brain on PET scanning. The cardiovascular risk factors included smoking, hypertension, diabetes, high cholesterol, and obesity. They were measured at an average age of 52, and about 20 years later the PET scanning was done. Having even one of these risk factors was associated with about double the odds of brain amyloid deposition, and having two or more was related to about triple the odds, and this was true irrespective of APO-E4 allele status.

What about physical activity? We know that it's so important for cardiovascular health. A recent report in the British Journal of Sports Medicine[2] was a meta-analysis of 39 randomized clinical trials of physical activity, showing that it's strongly linked to slowing of cognitive decline. The types of activity linked to slower rates of decline included aerobic exercise, resistance training, and even tai chi. We know from other evidence that even walking, particularly brisk walking, is strongly related to healthy cognitive aging.

What about diet? There's increasing evidence that the Mediterranean dietary pattern is promising for slowing the rate of cognitive decline. One line of evidence is the PREDIMED randomized trial[3] from Spain, where the Mediterranean diet (which included supplementation with either extra-virgin olive oil or nuts) was tested for cardiovascular outcomes, as well as in a subset for cognitive decline. There was less cognitive decline—a slower rate of decline—among those participants who were randomized to the Mediterranean diet compared with the control diet. There's also some evidence from Scotland, in a cohort study,[4] that those following the Mediterranean diet had less decline in brain volume on MRI over 3 years.

Last, I want to mention sleep, because the evidence is growing that it's very important for cardiovascular health and it also plays a role in preventing cognitive decline. We now have evidence that during sleep, there are structural changes in the brain, including expansion of the interstitial space, and there may be increased clearance of amyloid from the brain during sleep. We know that getting adequate sleep is linked to a lower risk of having diabetes, insulin resistance, obesity, cardiovascular disease, and even stress and depression. These are all risk factors for cognitive decline.[5]

Overall, the recent evidence further reinforces the mantra that what's good for the heart is good for the brain, and provides further incentive to talk with our patients about these findings to encourage them to manage cardiovascular risk factors and have healthy lifestyle practices.

Thanks so much for your attention. This is JoAnn Manson.

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