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Heart, brain and mental health conditions can overlap in ways doctors and patients should be aware of and address, according to new Canadian guidelines.
Monday’s issue of the Canadian Medical Association Journal lists 11 recommendations in total to benefit a person’s heart and cardiovascular system as well as lower their risk of dementia.
“I think many people aren’t aware that if they have heart disease, they are potentially at risk for having a stroke or cognitive impairment,” said lead author Jodi Edwards, a scientist and director of the Brain and Heart Nexus Research Program at the University of Ottawa Heart Institute.
“At the same time, the benefit is that if you properly manage those risks and reduce your risk of heart disease, you get benefits for your brain as well,” said Edwards, an associate professor at the University of Ottawa.
Edwards called the new recommendations timely given the increase in people with multiple chronic conditions as the population ages, as well as greater detection of flutters in the heart.
The flutter can be atrial fibrillation, the most common type of irregular heartbeat or arrhythmia, which physicians say puts you at a higher risk for stroke and heart failure.
The recommendations include:
- Screening people with atrial fibrillation for risk of cognitive decline.
- Screening for depression in people with coronary artery disease and treat with evidence-based therapies if detected.
- Starting intensive blood pressure or hypertension lowering in people at increased cardiovascular risk to lower the risk of cognitive impairment.
- Starting intensified cholesterol lowering to prevent heart attack in people with a history of stroke, and to prevent stroke in people after a heart attack or myocardial infarction.
- Routinely offering influenza, pneumococcus and shingles vaccination, especially to people aged 65 years and older, to help prevent stroke, heart attack and vascular cognitive impairment.
Specifically, Edwards suggested controlling high blood pressure for dementia or more regular monitoring after screening.
New guidelines out of the University of Ottawa Heart Institute are encouraging doctors in Canada to screen and treat heart, brain and mental health conditions in an integrated way.
Geriatrician Samir Sinha, a clinician scientist at Sinai Health and Toronto’s University Health Network, welcomed the new guidelines, which he was not involved in developing.
“What’s good for your heart is good for your brain,” Sinha said, noting he often holistically brings up both areas with his patients.
Sinha suggested the recommendations could have included more, such as how the Lancet Commission noted that if someone has diabetes, getting it under control also helps prevent the future risk of dementia as well as reducing the risk of heart attacks and strokes.
Sinha said he hopes primary care providers and others who read the guidelines will increasingly think more like geriatricians as well as heart, brain and mental health specialists.
