Patients diagnosed with common cardiac conditions should also be screened for dementia and depression, new brain-heart clinical guidelines recommend.
The
guidelines
— the first of their kind in Canada — recognize the strong connection between heart disease and brain disease as well as the importance of screening the whole person rather than focusing on one disease at a time. Clinical guidelines bring together the latest evidence on how health providers should be treating patients and makes recommendations. Guidelines usually apply to specific areas of treatment, such as how to manage patients with heart disease. This is the first to treat someone who has both heart and brain disease, which is not uncommon.
Numerous studies have found links between common cardiovascular diseases such as atrial fibrillation and heart failure and cognitive impairment, including increased risk of dementia.
The new Canadian guidelines were published in the Canadian Medical Association Journal. They are aimed at encouraging early diagnosis and prevention, in some cases by recommending vaccinations associated with reducing risks of cardiovascular disease, stroke and possibly dementia.
Dr. Jodi Edwards, lead author and director of the Brain and Heart Nexus Research Program at the
University of Ottawa Heart Institute
, said growing recognition of the connection between heart and brain disease motivated the guidelines.
“There is a close interplay between heart and brain diseases,” she said, adding that many heart and brain diseases shared overlapping risk factors and numerous other connections. “As a result, heart and brain conditions frequently co-occur and confer reciprocal increased risks.”
Heart disease can result in reduced brain blood flow through several mechanisms, which increases the risk of cognitive issues.
Numerous studies have looked at the relationship between cardiac diseases and cognitive impairment. One found that atrial fibrillation was associated with a 39 per cent increased risk of cognitive impairment in the general population and that it may increase the risk of early-onset dementia.
Atrial fibrillation is the most common type of sustained irregular heart rhythm, related to electrical signal dysfunction. It can lead to blood clots, strokes and heart failure. Up to roughly half a million Canadians — or higher — may be affected. By the age of 80, it affects as much as 10 per cent of the population.
There are also strong links between heart disease and depression. Both depression and anxiety are considered under-recognized risk factors for women with cardiovascular disease.
The guidelines make a number of recommendations specifically about screening for patients diagnosed with certain cardiac conditions. They are meant to help inform health professionals whose patients have diagnoses related to cardiovascular disease or risk factors, Edwards said.
Those recommendations include: screening people with atrial fibrillation for risk of cognitive decline; screening for depression in people with coronary artery disease and treating with evidence-based therapies if detected.
The guidelines also recommend that people with high blood pressure and increased cardiovascular risk be treated with intensive blood pressure-lowering treatment to reduce the risk of cognitive impairment and that “intensive” cholesterol-lowering treatment be given to people with a history of stroke to prevent heart attack and similar treatment to prevent stroke in patients who have had a heart attack.
The guidelines also call for health providers to routinely offer patient 65 and over flu, pneumococcus and shingles vaccinations to help prevent stroke, heart attack and vascular cognitive impairment.
There is a growing body of evidence about the protective benefits of some vaccines against risk of cardiovascular disease and even cognitive impairment.
Recent studies conducted in Canada and around the world indicate that the shingles vaccine, particularly Shingrix, is associated with a significantly lower risk of developing dementia.
A new study also found that adults with heart disease who received shingles vaccine experienced fewer heart-related complications within a year than those who were not vaccinated.
Edwards said taking a whole-person approach to screening and treatment recognized the reality of chronic illness.
“Almost no patients come through the door with only one thing.”
Recognizing related risk factors will help better manage the treatment of patients for better results, she said.
From the beginning, patients were involved in the process and helped shape the recommendations, she added.
The research was funded by the Canada First Research Excellence Fund for the University of Ottawa Brain Heart Interconnectome research program.
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