​Heart Disease Raises Dementia Risk

Are women at higher risk than men?

PULSE Issue 41 | July 2023

Are you ruled by your head or your heart? There is scientific basis for the heart-brain axis that is no longer a mere sensational metaphor. Evolving research has shown that women with heart disease are strongly linked to cognitive decline (Dementia), more so than men. Dementia is a general term describing conditions which lead to a decline in the mental ability, severe enough to disrupt daily life. Dementia is not a normal part of aging and is instead, caused by damage to brain tissues which affects thinking, behaviour and feelings. There are different types of Dementia including Alzheimer’s Disease, Vascular Dementia and Lewy Body Dementia. In the recent Well-being of the Singapore Elderly (WiSE) nationwide study, the prevalence of Dementia was found to be one in every 10 people aged 60 years and above. This disease is well-known to affect more women than men, where two out of three people with Alzheimer’s Disease are women. 

It is also strongly associated with various cardiovascular disorders. Heart and brain disorders more frequently co-exist than by chance alone, due to having common risk factors and a degree of interaction. Women with history of heart disease are more likely to experience cognitive loss with age. There has been increasing evidence on a broad scale documenting women’s predisposition to Dementia with heart-related issues. This is especially so for older and postmenopausal women. 

In a long term study published in the Journal of the American Heart Association, of more than 6,000 women aged 65-79, female heart attack survivors are twice as likely to experience decline in memory and cognition. In another population-based cohort study of more than 500,000 individuals, data showed that women with Coronary Heart Disease and Heart Failure were 1.6 and 1.3 times more likely to develop Alzheimer’s Disease than men with the same condition. Even without Heart Disease, women with Hypertension and Diabetes are at a higher risk of cognitive decline than men. The usual risk factors for Heart Disease and Stroke, applies to Dementia too. Heart Disease is more than just blocked or damaged arteries, it is also an inflammatory process that can affect the turnover of brain cells, leading to small bits of tissue death in the brain over time.

WOMEN ARE MORE LIKELY TO HAVE RISK FACTORS LINKED TO INCREASED RISK OF DEMENTIA, SUCH AS:

• Increased prevalence/severity of Hypertension & Diabetes (especially >64 years old)
  
• Increased Stroke Risk with Atrial Fibrillation (AF), Bypass Surgery, Aortic Valve Procedures: When it comes to stroke prevention for those with AF, women were found to have been less aggressively treated with blood thinners than men were. Women are also found to have higher rates of stroke when undergoing Heart Bypass Surgery and Transcatheter Aortic Valve Procedures, but reasons for this difference is still unclear.
  
• Systemic Inflammation 
  
• Microvascular (small coronary vessel) Disease / Dysfunction
  
• Oestrogen / Androgen (sex hormone) balance
  
• Physical inactivity and obesity
  
• Increased longevity: As women generally have a longer life expectancy than men, women are more at risk of developing Dementia with age. Unfortunately, this also means that women living with heart disease and Dementia carry a larger burden of disease in their lifespan compared to men.
  

Heart disease is reversible, dementia is not 

80% of Cardiovascular Disease is preventable by having a healthy lifestyle. Everyone, men or women, can do their part by maintaining a healthy diet by incorporating a daily intake of such as fresh fruits and vegetables, staying physically and mentally active, and paying attention to their blood pressure, blood sugar and cholesterol levels. All these efforts can not only prevent Heart Disease, but also prevent cognitive impairment and Dementia.

Learn more about NUHCS Women's Heart Health Programme.