Heart-Brain-Metabolism Axis Links Cardiovascular Disease to Cognitive Decline

This state-of-the-art review examines the intricate connections between heart, brain, gut, and metabolic systems, revealing how their dysfunction contributes to vascular cognitive impairment and dementia (VCID). Understanding these relationships is crucial as cardiovascular disease increasingly links to cognitive decline in aging populations.

The authors describe complex bidirectional pathways connecting cardiovascular health, brain function, autonomic nervous system, gut microbiome, and liver metabolism. These interconnected systems influence each other through immune and gastrointestinal pathways, creating a multifaceted network susceptible to pathologic processes across multiple organ systems.

Key therapeutic insights include emerging approaches for cognitive risk prediction in cardiovascular patients, such as clinically accessible assessment tools for older adults and brain imaging biomarkers that link stress-related neural activity to future cardiovascular events. The review highlights gut microbiome modulation as a novel intervention strategy.

Evidence supports statins' cognitive safety and potential neuroprotective benefits, while ongoing trials investigate integrated cardiovascular, neurocognitive, and metabolic interventions. The authors emphasize preventative approaches with early identification of cardiovascular and neurologic risk factors to enable timely therapeutic intervention.

This framework suggests that treating cardiovascular disease and cognitive decline requires integrated approaches targeting the entire heart-brain-metabolism axis rather than isolated organ systems, potentially revolutionizing prevention strategies for age-related cognitive impairment.