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AHA/ASA: Heart-healthy lifestyle also benefits brain health
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A heart-healthy lifestyle can improve brain health in adults and reduce the risk for cognitive decline, including dementia, according to a presidential advisory from the American Heart Association and American Stroke Association published in Stroke.
“Research summarized in the advisory convincingly demonstrates that the same risk factors that cause atherosclerosis are also major contributors to late-life cognitive impairment and Alzheimer’s disease,” Philip B. Gorelick, MD, MPH, FAHA, executive medical director of Mercy Health Hauenstein Neurosciences in Grand Rapids, Michigan, and the chair of the advisory’s writing group, said in a press release. “By following seven simple steps — Life’s Simple 7 — not only can we prevent heart attack and stroke, we may also be able to prevent cognitive impairment.”
Defining optimal brain health
Gorelick and the advisory writing group systematically reviewed available data and evidence to define optimal brain health and how to maintain it using similar approaches to maintain CV health, as they are associated with one another.
Modifiable risks such as uncontrolled hypertension, obesity, diabetes, smoking, physical inactivity and depression have been linked to compromised brain health, according to the advisory.
Optimal brain health was theoretically defined as “optimal capacity to function adaptively in the environment,” the authors wrote. Although the advisory focuses on adult patients, interventions to reduce risk should begin in young adulthood or even childhood.
The writing group used the AHA’s Life’s Simple 7 strategy to develop methods to maintain brain health, including physical activity, nonsmoking status, healthy diet, BMI less than 25 kg/m2, untreated BP less than 120/80 mm Hg, fasting glucose less than 100 mg/dL and untreated total cholesterol less than 200 mg/dL.
“Although the importance of these factors with respect to optimal brain health is acknowledged, AHA’s Life’s Simple 7 was chosen to be the backbone of the definition of the metrics because of their relevance on individual and population levels, life-course perspective and fit with the ability to monitor, measure and modify, and because they further affect other established risk factors for brain health, including atrial fibrillation,” Gorelick and colleagues wrote.
Screening, maintaining brain health
Questionnaires can be used to screen brain health, including those that assess daily function, problem-solving, mood and mobility. Calculating lifetime risk estimates for young and middle-aged patients may motivate them to take responsibility to preserve their brain health.
Maintaining both good CV and brain health can be cost-effective because Alzheimer’s disease and other dementias are the most expensive diseases to treat in the United States, according to the advisory.
“Prevention of cognitive impairment and dementia may be viewed as a lifelong process predicated on a number of antecedent factors, with cardiovascular risks playing an important role,” Gorelick and colleagues wrote. “The promotion of healthy living across the lifespan may allow one to avoid adverse health outcomes such as multimorbidity, including cognitive impairment and other health-related adverse outcomes or events. In addition, favorable cardiovascular health may be associated with lower health care expenditures and resource use.”
The AHA and ASA have set a goal to improve CV and brain health and reduce CVD mortality and stroke in the United States by 20% by 2020. – by Darlene Dobkowski
Disclosures: Gorelick reports no relevant financial disclosures. Please see the advisory for all other authors’ relevant financial disclosures.
Perspective
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Larry B. Goldstein, MD, FAAN, FANA, FAHA
The advisory reviews and synthesizes the existing data supporting approaches to optimize brain health, but was not intended to provide new information to expand the knowledge base.
This has implications for the public and clinical practice. Because of the link between some CV risk factors and brain blood vessel disease, lifelong approaches aimed at optimizing CV health would also be expected to improve brain help, including a reduction or delay in cognitive impairment. The panel endorsed the AHA’s “Life Simple 7” as a guide for optimizing brain health.
Additionally, long-term studies are needed showing that following optimal CV lifestyle recommendations not only reduce stroke and heart disease, but improve cognitive outcomes.
We know that those who follow healthy lifestyle habits (exercise regularly, have a normal BMI, don’t smoke, don’t drink excessive alcohol, and eat a healthy diet such as the DASH or Mediterranean-type diet) have an 80% lower risk for a first stroke compared to those who don’t follow these optimal lifestyle measures. This should also translate to overall improved brain health.
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