Alzheimer's and The Heart-Brain Link

03/30/2021 | 6 min. read

Dr. Stephen Sinatra

Dr. Stephen Sinatra

Alzheimer’s is one of the most feared of all diseases and with good reason. It affects more than 5.5 million Americans. It is irreversible, progressive, and incurable. Plus, it erodes your memories, personality, and self-awareness—the things that make you, you.

There are a lot of unknowns about this devastating disease. What we do know is that age is the greatest risk factor. Once you reach 65, your likelihood of developing Alzheimer’s doubles every five years. We know that certain genetic variations, serious head injuries, diabetes, and alcohol abuse increase risk. 

We also know about the links between Alzheimer's and heart disease—and that addressing common cardiovascular risk factors protects against both heart disease and Alzheimer's. 

Poor Blood Flow Is a Culprit 

The brains of patients with Alzheimer's disease are littered with beta-amyloid plaques and neurofibrillary tangles that disrupt function and destroy brain cells. Although these are considered to be the defining characteristic of Alzheimer's, other degenerative changes are also present—most notably vascular problems that affect blood flow in the brain. 

You don’t have to be a brain surgeon to recognize that robust delivery of oxygen- and nutrient-rich blood is essential for optimal brain function. This is true of all your organs, but your brain is a particularly voracious consumer, accounting for about 20% of total oxygen and glucose utilization. 

Good blood flow is dependent on a healthy cardiovascular system. Disorders that damage the blood vessels or the heart’s pumping ability may result in inadequate blood delivery and poor perfusion (the circulation of blood through tissues). 

Any significant degree of restricted blood flow in the brain causes energy deprivation, oxidative stress, rampant inflammation, breakdown of the blood-brain barrier, and the accumulation of toxins—destructive processes that contribute to the neurodegenerative changes associated with Alzheimer’s. 

Blood Pressure & Alzheimer's Disease 

Hypertension is a major risk factor for both heart disease and Alzheimer's. Chronically high blood pressure damages the blood vessels—including the small vessels in the brain. Over time, this sets into motion the neurodegenerative processes that can lead to dementia. 

An important thing to note is that the damage begins years before cognitive problems become evident. Italian researchers performed MRIs on men and women ages 40–65 and found that those who had hypertension had early signs of damage in areas of the brain involved in attention, memory, and emotions.

The good news is that hypertension is a risk factor you can control—and multiple studies have shown that controlling blood pressure reduces the risk of dementia. One study, a 2020 meta-analysis published in Lancet Neurology, found that older people with hypertension who took blood pressure-lowering medications were considerably less likely to develop dementia. There were no significant differences between various classes of antihypertensive drugs, leading to the conclusion that any drug that effectively lowers blood pressure may reduce the risk of dementia. 

Although this and most of the other studies of this nature focus on drugs, medication is not the only way to control hypertension. Many of my patients have had excellent results on a natural program for lowering blood pressure.

Alzheimer’s Disease & the Cholesterol Connection

Contrary to popular belief, elevated cholesterol is not a major contributor to cardiovascular disease. Likewise, there isn’t any overwhelming evidence linking it with Alzheimer's. A high HDL cholesterol level has been shown to be protective, but study results on elevated LDL as a risk factor are inconsistent. 

Cholesterol-lowering statin drugs have been proposed as a preventive, but I don’t buy it. A Cochrane Review of double‐blind, randomized, placebo‐controlled trials concluded, “There is good evidence that statins given in late life to people at risk of vascular disease do not prevent cognitive decline or dementia.”

If anything, you should be more concerned about low cholesterol and Alzheimer's disease. About 20% of the cholesterol in your entire body is in your brain. It is an important component of myelin, which insulates neurons, and synapses, which are the junctions where nerve impulses are transmitted. 

In fact, cholesterol is so essential to brain health that your brain makes its own supply. So, low cholesterol is rarely a problem—unless you are on a statin drug. All statins are required to include a warning in their product inserts noting “... reports of cognitive impairment (e.g., memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with statin use.” A likely explanation is the suppression of cholesterol and coenzyme Q10 synthesis in the brain. 

Other Cardiovascular-Alzheimer's Risk Factors

Additional links between cardiovascular disease and Alzheimer's include:

  • Inflammation: This is a big one—for both cardiovascular disease and Alzheimer's. Chronic inflammation, triggered by an unhealthy lifestyle, obesity, infections, allergies, heart disease, and chronic illness, promotes the formation and progression of beta-amyloid plaques, vascular damage, and other neurodegenerative processes. 
  • Stroke: A stroke occurs when the blood supply is cut off to an area of the brain, resulting in serious damage to affected areas. Strokes and “mini-strokes” dramatically increase your risk of vascular dementia, which is the second most common type after Alzheimer’s. However, studies suggest that most people with progressive memory loss have “mixed dementia”—both vascular and Alzheimer's. I have been asked if Alzheimer's can cause a stroke. It does increase risk, but a stroke is more likely to be a cause of dementia rather than a consequence.
  • Heart attack: Although heart attacks do not cause Alzheimer's, a heart attack is a sign of atherosclerosis: the buildup of plaque in the blood vessels. Atherosclerosis is a systemic disease, and if it affects your coronary arteries, it probably affects other blood vessels—including those that supply your brain. 

What’s Good for the Heart…

What’s good for your heart is good for your brain, so my recommendations are similar for both:

  • Eat an anti-inflammatory diet. Traditional Mediterranean and Asian diets have proven benefits for cognitive function. Plus, olive oil, fatty fish, vegetables, and other foods that keep your memory sharp enhance cardiovascular health as well. Eliminating sugars and processed carbohydrates, which promote insulin resistance and diabetes, is also recommended, as these conditions are linked with Alzheimer's. 
  • Get plenty of exercise. In addition to optimizing cardiovascular health and brain blood flow, exercise triggers the release of growth factors that stimulate the formation of new neurons. Studies show that regular physical activity not only reduces the risk of developing dementia but also helps slow disease progression in the early stages of Alzheimer's. Don’t forget to exercise your brain. Mental stimulation improves cognitive reserve—your brain’s resilience to damage or degeneration. Education and a lifetime of learning contribute to cognitive reserve. Playing games, learning new skills, reading, and other activities that challenge your brain may also help. 

The upside is that by taking steps to enhance your heart health, you are doing double duty and supporting the health of your brain at the same time. And as Nelson Mandela once said, “A good head and a good heart are always a formidable combination.”

Dr. Stephen Sinatra

Meet Dr. Stephen Sinatra

Dr. Stephen Sinatra is a highly respected and sought-after cardiologist and nutritionist with more than 30 years of clinical practice, research, and study. His integrative approach to heart health focuses on reducing inflammation in the body and maximizing the heart's ability to produce and use energy.

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