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A healthy heart means a healthy brain: The Heart Brain Connection

Dr Aw headshot in a circle

Update from Dr. Aw

February 19, 2021

As we celebrate Valentine’s Day this month, we are all reminded of the ones we love, or perhaps a chance to flirt and show our romantic side to someone special. It is curious how powerful emotions, (happy or sad), can deeply affect how we physically feel in the moment. That visceral warm and tingling feeling when experiencing an act of love and kindness or that horrible wrenching chest and gut feeling when someone has “broken your heart”. There is a medical condition called Takotsubo stress cardiomyopathy where you could even die of a broken heart. An intense emotional or stressful event leads to a nervous system response that releases neurochemicals (catecholamines) causing spasm of your heart muscles and swelling in one of your chambers leading to temporary heart failure. On x-ray the heart muscle looks like a Japanese container used to trap octopus (hence named Takotsubo!). There is a higher prevalence of underlying anxiety and depression in these patients, but fortunately, this condition is rare and reversible with supportive treatment.

What about the effects of chronic stress on the heart? The famous Whitehall studies in the United Kingdom in the 1960s looked at stress from “unhealthy work” in civil servants and found a connection between chronic stress from job strain and increased mortality from cardiovascular disease. The more recent Interheart study (25,000 participants across 52 countries) found that emotional stress was a key risk factor associated with approximately one-third of heart attacks and strokes. Acute or chronic stress can activate the “fight-or-flight” response that triggers a cascade of biochemicals like adrenaline that can increase heart rate, blood pressure and lead to other effects (cortisol, neuropeptides, coronary artery spasms). Research is emerging on the connection between the emotional coding part of the brain (amygdala) and heart and stroke outcomes. No surprise that better emotional health is good for your heart!

I have always been fascinated by the Heart Brain Connection. Heart and stroke disease (cardiovascular disease) can accelerate cognitive decline and be a risk factor for dementia. Cardiovascular disease in middle age can be a predictor of future brain functioning decline. The Maastricht Aging Study (MAAS) was a famous 12-year follow up study of cognitively healthy individuals (age 24-82, n=1823) who underwent extensive executive function testing (memory, information processing speed) and found cognitive impairment was more frequent in those with cardiovascular disease. Interestingly – the stronger associations were among younger individuals with risk factors who developed progressive cognitive impairment rather than later in life.

Shared risk factors and mechanistic pathways likely explain the heart brain connection. Several studies have shown the association of midlife high blood pressure, diabetes and low physical activity with lower cognitive functioning. It seems that the accumulation of multiple risk factors over the life course worsens the risk of brain decline as opposed to a single factor. The shared biological mechanisms are also likely a combination of a predisposition to chronic inflammation, clotting, strokes, lower heart function (output) and arrhythmias (like atrial fibrillation).

The heart-brain connection: common risk factors and mechanistic links over the life course.

Life course: 15-39 years - Cardiovascular risk factors: age, smoking, sedentary lifestyle, obesity, diabetes, hypertension, high cholesterol, hyperlipidemia. 40-59 years - Subclinical atherosclerosis inflammation and oxidative stress in: heart, brain, kidney, retina, peripheral blood vessels. 60-74 years - Heart disease / coronary disease: angina pectoris, myocardial infarction, atrial fibrillation, heart failure, cerebral hype perfusion, hypoxia, emboil. Over 75 years - brain lesions: stroke, white matter lesions, neurodegeneration (plaques and tangles_, disruption of BBB, lacunar infarcts and will cause cognitive decline, dementia, mild cognitive impairment.

Source:   Eur Heart J, Volume 38, Issue 43, 14 November 2017, Pages 3229–3231,

So how do we keep a healthy heart brain connection?

It is important to stay informed (health literacy) on modifiable risk factors and master “self-efficacy” of daily dietary, physical and emotional healthy behaviours. It is always good to assess your “Heart Age”. The CDC has a nice online tool based on the Framingham Study of risk stratification.

It is also critical to continue any prescribed medications (i.e. statins for lipids, anti-blood pressure pills, diabetic medications, etc.) and check in regularly with your health care provider to avoid delays in testing or treatment. The pandemic has taught us about the importance of societal and behavioural factors on prevention. COVID-19 has led to a significant drop in cardiovascular testing globally and delays in diagnosis and care for preventable diseases. The lack of compliance with universal mask wearing has led to COVID-19 infections which are now known to be associated with cardiovascular, neurological disease and “brain fog” in long hauler patients (long COVID). Simply wearing a mask during a pandemic may protect your heart and brain!

Ultimately - a more holistic approach will be helpful to preserve a healthy heart-brain connection versus an oversimplified disease centric approach (i.e. healthcare in silos). It is important to focus on your emotional and brain health to protect your heart.

Here are five daily lifestyle practices to reduce stress and improve neurochemical responses from cardiologist Dr. Michael Miller who is the author of “Heal your Heart, The Positive Emotions Prescription to Prevent and Reverse Heart Disease”:

  1. Meditation (serotonin activated relaxation practices)

  2. Yoga (GABA induced mood stabilization)

  3. Laughter (endorphin mediated visual effects)

  4. Music (dopamine regulated auditory effects

  5. Massages, hugging (oxytocin activated tactile responses)

Albert Einstein once said, “Don’t let your brain interfere with your heart.” The heart and brain are interlinked as much as humans are to each other. Your brain health affects your heart health and vice versa. During this pandemic, remember to take daily breaks and recharge. Humans were never meant to sit in front of a screen for all hours of the day. Unplug and give yourself permission to take some timeouts. So - for this Valentine’s Day month – give someone (pets count here too!) a hug or share some laughs and music with loved ones. These simple daily acts are great for the heart brain connection and is just what the doctor ordered!


  1. Tako-tsubo cardiopathy (Broken Heart);

  2. Whitehall studies

  3. The Heart Brain Connection


  5. ​​​​​​​International impact of COVID-19 on the diagnosis of heart disease

  6. Emotional Rescue: The Heart-Brain Connection

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