Researchers have found that individuals with heart conditions are more likely to have silent brain infarction (SBI) and cerebral small vessel disease (CSVD). These conditions can lead to an increased risk of stroke and dementia. The review of over 220 studies revealed that changes to the blood vessels in the brain, which are detectable only through brain imaging, are prevalent among people with heart diseases such as atrial fibrillation, coronary artery disease, heart failure, cardiomyopathy, heart valve disease, and patent foramen ovale. SBI was found in one in three individuals with heart disease, with two-thirds having white matter lesions, a quarter experiencing asymptomatic microbleeds, and more than half having brain atrophy.
Dr. Michael Ross MacDonald, a cardiologist at The Harley Street Heart and Vascular Centre in Singapore, explained that when the blood vessels in the brain become narrow and blocked, it can impede blood flow to certain areas of the brain. This damage can accumulate over time and lead to symptoms of vascular cognitive impairment and eventually progress to vascular dementia. The study, published in Neurology, highlighted the importance of early detection of these changes in the brain’s vascular system among individuals with heart conditions.
Dr. Gregory Bix from Tulane University emphasized that SBI and CSVD are often overlooked cardiovascular health conditions with insidious onset of cognitive symptoms that are frequently missed in the early stages. CSVD is a major cause of vascular dementia, ranking second only to Alzheimer’s disease. The researchers noted that even individuals who had not previously experienced a stroke showed elevated prevalence of these brain vascular changes, indicating that routine brain imaging for people with heart disease could be crucial for detecting these issues early on.
Lead study author Dr. Zien Zhou from The George Institute for Global Health in Sydney, Australia, highlighted that individuals with heart conditions are at a higher risk of developing brain bleeds from medications commonly used to treat or prevent blood clots. This can lead to intracranial hemorrhage, a life-threatening complication with a survival rate of less than 50 percent. Zhou pointed out that aging, hypertension, type 2 diabetes, high cholesterol, and smoking are among the likely causes of hidden changes in the brain’s blood vessels, which can contribute to cognitive dysfunction in individuals with heart disease.
Further research is needed to explore whether routine brain imaging for patients undergoing anticoagulation therapy, including most individuals with heart disease, could help reduce risks such as bleeding in the brain. Dr. Bix suggested that individuals with atrial defibrillation, coronary artery disease, heart failure or cardiomyopathy, and heart valve disease should undergo brain scanning to detect SBI and CSVD. While the study underscores a clear correlation between heart disease and these brain conditions, the causative link between the two remains to be determined. The findings emphasize the need for early detection and management of SBI and CSVD in individuals with heart conditions to prevent potential cognitive dysfunction and dementia.
