TORONTO – Scientists have found much deeper links between cardiovascular disease and the risk of cognitive impairment than previously known, enhancing the message to the Canadians that it is taking steps to prevent heart disease and stroke also protect the brain.
A study by researchers in the Heart and Stroke Foundation surveyed the associations between heart disease, stroke and the development of vascular cognitive impairment, a condition due to diseased blood vessels delivering the brain.
"The most striking result is that people with heart disease have a significantly increased risk of vascular cognitive impairment and possibly dementia due to their underlying vascular disease," said Heart and Stroke CEO Yves Savoie.
In a report released on Thursday, the authors report their results from an analysis of 2.6 million hospitalizations by Canadians with cardiovascular disease between 2007 and 2017. They found that individuals treated for a cardiovascular condition were on the increase risk of developing multiple related conditions that could result in hospital readmission or death.
"We found much more connections than anyone ever appreciated," co-author Patrice Lindsay said, and the study also included a review of previous studies into the issue of medical literature.
40% of patients were re-administered one or more times for a new related disease found in the study. Many developed into serious illnesses and medical emergencies, with a larger proportion of women affected than men.
"It not only lives with heart disease or stroke, it's the increased risk in complications of having multiple conditions," said Lindsay, director of system change and stroke on the foundation. "And the fact that all these put you at higher risk of dementia."
Jennifer Monaghan, 49, suffered a severe stroke almost seven years ago, temporarily paralyzing her right side and robbing her of speech. While she was able to learn to speak again with rehabilitation, she was left with permanent cognitive deficits.
The former lawyer and mother of two said she knew her cognitive function, not what it once was.
"I often use incomprehensible the wrong word or I can't come up with the word I want," said Monaghan from her home in Kelowna, B.C. "I find my memory is not as strong as it used to be."
What is particularly confusing and frustrating for Monaghan was her lack of risk factors for stroke – she had no family history, was not overweight, exercised regularly and ate a healthy diet.
It's worse she has now developed heart failure, a chronic condition where the heart muscle is unable to pump enough oxygen and nutrient-rich blood to adequately meet the needs of the body and brain.
"Anyone I've seen for my health issues, no one has put me down and said they're related, and I should be aware of how much at risk I'm about to develop another," Monaghan said. "And I don't know what to do to avoid more cognitive decline."
It was another problem raised by the Heart and Stroke report: the health system gaps.
Because the system is designed to substantially treat a disease at a time, patients with cardiovascular disease at risk of related conditions are often exposed to long waiting times to see different specialists for diagnosis and treatment.
Such layers can lead to worsening of disease, Lindsay said. "We need more integrated care, where patients like to do one-stop shopping and not have long delays between specialists."
The report also focuses on individual Canadians, and encourages them to practice primary prevention through healthy lifestyle choices.
"We need people to appreciate that if you go out and get your 10 minute vigorous exercise a day, it's not just to help your heart, it's to help your heart, prevent strokes, and prevent or delay dementia, "she said.
"With our aging population, when we look at it this way, it is like a big red flag – we have a big problem on our hands. As people grow old when the population gets older, we will see more and more of these conditions … and our (healthcare) system is not really built to handle it. "
Some other results:
– People with heart failure were 2.6-fold more likely to experience vascular cognitive impairment while those with heart rhythm atrial fibrillation were 1.4-fold more likely to experience VCI.
– Those with heart valve disease were found to have a 25 percent increased risk of vascular cognitive impairment.
– And almost a third of the patients who had another stroke were at risk of developing VCI.
"It turns out that in the brain itself, new degeneration and vascular diseases are very intertwined," said neurologist Dr. Vladimir Hachinski, an expert in stroke and dementia at Western University.
"We're going to realize that any size blood vessels, whether they are aorta or coronary vessels, are very closely related to what's happening in the brain," he said from London, Ont. "Because if they don't work, they can't supply the brain well, and the brain suffers as a consequence."
– Follow @SherylUlacker on Twitter.
Sheryl Ubelacker, The Canadian Press