Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association

Abstract

Cognitive function is an important component of aging and predicts quality of life, functional independence, and risk of institutionalization. Advances in our understanding of the role of cardiovascular risks have shown them to be closely associated with cognitive impairment and dementia. Because many cardiovascular risks are modifiable, it may be possible to maintain brain health and to prevent dementia in later life. The purpose of this American Heart Association (AHA)/American Stroke Association presidential advisory is to provide an initial definition of optimal brain health in adults and guidance on how to maintain brain health. We identify metrics to define optimal brain health in adults based on inclusion of factors that could be measured, monitored, and modified. From these practical considerations, we identified 7 metrics to define optimal brain health in adults that originated from AHA’s Life’s Simple 7: 4 ideal health behaviors (nonsmoking, physical activity at goal levels, healthy diet consistent with current guideline levels, and body mass index <25 kg/m2) and 3 ideal health factors (untreated blood pressure <120/<80 mm Hg, untreated total cholesterol <200 mg/dL, and fasting blood glucose <100 mg/dL). In addition, in relation to maintenance of cognitive health, we recommend following previously published guidance from the AHA/American Stroke Association, Institute of Medicine, and Alzheimer’s Association that incorporates control of cardiovascular risks and suggest social engagement and other related strategies. We define optimal brain health but recognize that the truly ideal circumstance may be uncommon because there is a continuum of brain health as demonstrated by AHA’s Life’s Simple 7. Therefore, there is opportunity to improve brain health through primordial prevention and other interventions. Furthermore, although cardiovascular risks align well with brain health, we acknowledge that other factors differing from those related to cardiovascular health may drive cognitive health. Defining optimal brain health in adults and its maintenance is consistent with the AHA’s Strategic Impact Goal to improve cardiovascular health of all Americans by 20% and to reduce deaths resulting from cardiovascular disease and stroke by 20% by the year 2020. This work in defining optimal brain health in adults serves to provide the AHA/American Stroke Association with a foundation for a new strategic direction going forward in cardiovascular health promotion and disease prevention.

Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

“…The results of the current study lend further support and validation for the AHA's presidential advisory relating optimal brain health to the Life's Simple 7 metric. As explained by the AHA's presidential advisory panel, the Life's Simple 7 metric is an attractive tool for public health purposes because it can be measured, modified, and monitored easily and inexpensively over the life course 2. The results of this study also underscore the importance of continued measuring and monitoring of these 7 factors by primary care physicians in their patients throughout adulthood.…”

“…The AHA recently released a presidential advisory in which optimal brain health was operationally defined according to the Life's Simple 7 metric 2. In other words, the Life's Simple 7 metric at midlife was an important predictor of optimal brain health.…”

“…This finding is consistent with other studies showing that CVH in midlife is more predictive of brain health decades later than CVH in later life. Evidence is growing that the sensitive period for modifying late‐life cognitive and brain health is most likely at or before midlife, and that patients and physicians need to start addressing these health factors before midlife, given that waiting until late life may be too late 2. Whether modifying these risk factors later in life can effectively mitigate the detrimental effects of early‐ and mid‐adult poor CVH remains poorly understood.…”

“…It has been suggested that achieving ideal CVH could not only reduce heart disease and stroke, but also improve brain health 1. The AHA's 2017 presidential advisory on brain health2 described cognitive impairment and dementia as largely modifiable, and argued that achieving and maintaining ideal CVH in midadulthood, as defined by the Life's Simple 7 metric, may reduce the risk of cognitive impairment and dementia.…”

Cardiovascular health and dementia incidence among older adults in Latin America: Results from the 10/66 study

“…Dementia incidence has declined in some high-income countries, which might be partly explained by CVH improvements in these countries. 17 For example, the American Heart Association Life's Simple 7 CVH guidelines are based on four modifiable health behaviors (nonsmoking, healthy diet, physical activity, and body mass index [BMI]) and three modifiable biological factors (blood pressure [BP], total cholesterol, and fasting glucose). 13,14 Abundant evidence from high-income countries and some from Latin America shows that single cardiovascular risk factors and indices are associated with cognition and dementia.…”