Blood pressure, cholesterol, and elevated sugar levels - it all matters.
A healthy lifestyle benefits the brain as much as the rest of the body and can decrease the risk of cognitive decline (a loss of the ability to think well) as one ages, according to new recommendations from the American Heart Association (AHA) and the American Stroke Association.
Both the heart and brain need adequate blood flow, but in many people, blood vessels slowly narrow or block over the course of their lives, a disease process known as atherosclerosis, the cause of many heart attacks and strokes. Many risk factors for atherosclerosis can be modified by following a healthy diet, getting enough physical activity, avoiding tobacco products, and other strategies.
"The same risk factors that cause atherosclerosis are also the major contributors to cognitive decline in later life and Alzheimer's disease. By following seven simple steps- 'Life's Simple 7'- not only can we prevent heart attack and stroke, but we may also be able to prevent cognitive decline," says vascular neurologist Philip Gorelick, chairman of the recommendations group and executive medical director of Mercy Health Hauenstein Neurosciences in Grand Rapids, Michigan, USA.
Life's Simple 7
Life's Simple 7 outlines a set of health factors developed by the American Heart Association (AHA) to define and promote cardiovascular wellness. Studies show that these seven factors can also help promote optimal brain health in adults.
The 'Life's Simple 7' program urges individuals to manage blood pressure, control cholesterol, maintain normal blood sugar, be physically active, consume a healthy diet, lose excess weight, and not start or stop smoking. Having a healthy brain is defined as being able to pay attention, receive and recognize information from our senses, learn and remember, communicate, solve problems and make decisions, maintain mobility, and regulate emotions. Cognitive decline can affect any or all of these functions.
The recommendation, which appears in the American Heart Association's (AHA) "Stroke" journal, emphasizes the importance of taking steps to maintain brain health as early in life as possible because atherosclerosis, the narrowing of the arteries that causes many heart attacks, can begin in childhood. "There are ongoing studies to learn how heart-healthy strategies may impact brain health, even at an early age," says Gorelick, who, recognizing that more research is needed, calls the prospect "promising."
Elevated blood pressure, cholesterol, and sugar levels can cause large and small blood vessels to deteriorate, activating a cascade of complications that reduce blood flow to the brain. For instance, high blood pressure, which affects about one in three American adults, is infamous for damaging blood vessels that supply oxygen and nutrients to the heart and brain, Gorelick highlights.
The damage can lead to a buildup of fatty deposits, or atherosclerosis, as well as associated coagulation. This narrows the vessels, reduces blood flow to the brain, and can cause a stroke or "mini-strokes." The resulting mental decline is called vascular cognitive impairment or vascular dementia.
Previously, experts believed that the thinking problems caused by Alzheimer's disease and other similar illnesses were wholly separate from stroke, but over time researchers have learned that the same risk factors for stroke discussed in Life's Simple 7 are also risk factors for Alzheimer's and possibly some of the other neurodegenerative disorders, according to Gorelick.
The recommendation also acknowledges that it's important to follow guidelines previously published by the American Heart Association (AHA), the Institute of Medicine, and the Alzheimer's Association, which include controlling cardiovascular risks and suggest social engagement and other related strategies for maintaining brain health.
The action points of Life's Simple 7, based on findings from multiple scientific studies, fulfill three practical rules the panel developed for identifying ways to improve brain health that could be measured, modified, and monitored, points out Gorelick. These three criteria enable the translation of knowledge into action, as healthcare providers can easily assess simple elements of life like blood pressure; can encourage proven measures that promote health; and can measure changes over time.
The AHA advice provides a foundation upon which to build a broader definition of brain health that includes other influencing factors, says Gorelick, such as the presence of atrial fibrillation, a type of irregular heartbeat that has been linked to cognitive problems, education and literacy, social and economic status, the geographic region where a person lives, and other brain diseases and heart damage.
It's also a starting point for expanding research in areas such as whether there may be detectable markers, such as genetic or brain imaging findings, that represent susceptibility to cardiovascular or brain diseases, Gorelick advances.
"At some point in our lives, a 'switch' may be preparing to 'flip' or turn on, which puts us in a direction of risk for cognitive decline and dementia," he explains.
Dementia is expensive to treat. Direct care costs are higher than for cancer and nearly the same for heart disease, according to estimates. Additionally, the value of unpaid care for patients with dementia can exceed $200 billion per year. As lives grow longer in the US and elsewhere, around 75 million people worldwide may have dementia by 2030.
"Politicians will have to allocate healthcare resources for this," says Gorelick. Monitoring dementia rates in places where public health efforts are improving heart health "could provide important insight into the success of this approach and the future need for healthcare resources for the elderly," he says.
The authors of these recommendations reviewed 182 scientific studies published to formulate their conclusions that following Life's Simple 7 has the potential to help people maintain a healthy brain over their lifetime.