heart disease, stroke and cognitive decline have deep connections, says report

evelyn greenberg, pianist, teacher, volunteer and sister of former ottawa mayor jacquelin holzman had a stroke last june.luckily for greenberg, she knew the signs of a stroke and wasted no time in calling 911. less than three days later, she was sitting at a piano at the civic campus of the ottawa hospital playing those were the days. the stroke took no toll at all on the musical skills she has honed over almost eight decades.then, in october, greenberg felt her heart racing. the diagnosis: atrial fibrillation, or abnormal heart rhythm of the upper chambers of the heart.“it was a double whammy,” she says.researchers are warning that stroke, heart disease and cognitive decline are actually an interconnected triple whammy. a report from heart & stroke is urging the health-care system to pay attention to the “unseen” links between heart disease, stroke and vascular cognitive impairment.the report, released on thursday, is based on analysis of hospitalizations between 2007 and 2017 and a review of previously published studies. it concludes that there’s a deeper connection among the three conditions than was previously understood. people who have one condition have a significantly higher risk of developing, or might already have, multiple conditions. patients with more than one condition are up to eights times more likely to die in hospital than those with only one condition.but the report’s most startling conclusion is that people with heart conditions have a significantly increased risk of vascular cognitive impairment — a decline in thinking abilities caused by damage to the brain’s blood vessels. this may be subtle and mild and include problems with memory or concentration, but it may be as serious as vascular dementia, which makes it difficult to perform basic tasks, such as dressing.“there’s a lot of increased awareness that a lot of dementia has a vascular dimension,” said jodi edwards, the director of the brain and heart nexus research program at the university of ottawa heart institute and an assistant professor at the school of epidemiology and public health at the university of ottawa. but more research has to be done to determine how much that is, said edwards.the health-care system has done a good job of managing acute conditions. but it also means that patients are living longer and that gives them more time to develop overlapping conditions.the association among the three conditions is also complicated and depends on a number of factors, including the patient’s primary condition. for patients whose primary condition is congenital heart disease, for example, there’s a strong association with atrial fibrillation, stroke and cognitive impairment, but only a moderate relationship with heart failure and heart valve disease.it also depends on gender. women with heart failure have a six-fold increased risk of atrial fibrillation, 25 per cent higher than men, for example.dr. debbie timpson, a specialist in physical medicine and rehabilitation at the pembroke regional hospital, says some of the links are already clear. it’s already well known that vascular cognitive impairment can occur because a stroke has caused damage to the brain, or that an irregular heart beat like atrial fibrillation can cause a blood clot in the heart that travels to the brain and causes a stroke.but it was surprising to learn that the disease link goes both ways, she said. the report points out that people with vascular cognitive impairment have up to a 68 per cent increased risk of stroke.the report advises patients who have a heart condition, stroke or vascular cognitive impairment be sure their doctors are aware of related conditions. it’s also important for the health system as a whole to recognize that these illnesses can cross the boundaries of medical specialties.“our health systems are set up to deal with single disease states,” said edwards.she’s seeing some movement. although ottawa doesn’t have one, some other ontario cities have “vascular clinics” that treat patients with multiple conditions in one setting.the health-care system has become more collaborative and less fragmented, so patients get timely help, said timpson. renfrew county has recognized the overlap and has worked a way around it, despite limited resources. “we created a vascular health program where patients with heart disease, stroke, or diabetes can attend. and patients with a stroke can attend a cardiac rehabilitation program,” she said.meanwhile, prevention goes a long way, including quitting smoking, healthy diet and exercise.greenberg, who has become an ambassador for heart & stroke, has shown no signs of cognitive impairment. she has always carefully followed medical advice, is careful about her diet, walks as much as she can and tries to keep stress out of her life.“i’m not aware of any disability. but a stroke is not a broken leg,” she said. “a broken leg heals. with a stroke, you really don’t know what’s going on in your brain.”by the numbers91,524 canadians who died of heart conditions, stroke or vascular cognitive impairment in 20162.6 million hospitalizations of involving people who have at least one heart condition, a stroke or vascular cognitive impairment between 2016 and 201740 per cent proportion of patients readmitted to hospital one or more times for a new related illness