Leslie Cho, M.D. is the Director of the Women’s Cardiovascular Center, Section Head of Preventive Cardiology and Rehabilitation, and Chief Quality Officer in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic. She spoke with us about heart-healthy lifestyle choices and how they can also foster brain health.

Read the Q&A with Dr. CHo below.

WAM: We’re often told ‘what’s good for the heart is good for the brain.’ How are these two organs and their health outcomes related?
Dr. Cho: The brain is supplied blood through blood vessels that originate from the heart. Our blood vessels can become clogged, inflamed or rupture, resulting in complications to the brain and heart. Conditions like high cholesterol, high blood pressure, diabetes, obesity and smoking are risk factors for neurological and cardiovascular conditions alike, including vascular dementia, stroke, heart disease and atrial fibrillation. That is why diets that lower our heart disease risk and modification of these risk factors are also good for the brain. What’s good for the heart is good for the brain!

WAM: LDL cholesterol is described in villainous terms when it comes to causing heart attacks and strokes. How does building up cholesterol impact the heart in such a way that it can ultimately lead to having a stroke, and what does that stroke do to the brain?
Dr. Cho:
One in five women have a stroke, and it is the third-leading cause of death for women. Pregnancy-related conditions, certain contraceptive uses (like birth control pills) and changes during menopause are unique causes of stroke for women. Common causes shared between men and women include the aforementioned – high blood pressure, smoking and high cholesterol.

There are two types of stroke, the most common being ischemic strokes (account for ~80% of all strokes). Ischemic strokes occur when cells don’t get enough blood flow to supply them with oxygen, typically because something blocks blood vessels in your brain, cutting off the blood flow. These blockages can occur in the following ways:
· A clot forms in your brain, also called thrombosis.
· Part of a clot formed elsewhere in the body breaks away and travels through your blood vessels and lodges in the blood vessels in your brain. This clot is called an embolism. Embolisms can come from the heart and can be the result of a heart rhythm condition, called atrial fibrillation. Cholesterol can emobolize, too.
· Long-term, untreated high blood pressure, high cholesterol or high blood sugar (Type 2 diabetes) create small vessel blockages, also called a lacunar stroke.

The clots that create blockages can be formed by a condition called atherosclerosis, or arterial disease. Atherosclerosis is hardening of your arteries, caused by gradual plaque buildup from conditions like high cholesterol. Other heart-related conditions that can cause strokes are atrial fibrillation, aortic valve stenosis, endocarditis and patent foramen ovale, or PFO.

When you have a stroke, part of your brain loses its blood supply, which keeps that brain area from getting oxygen. Without oxygen, brain cells become oxygen-starved and stop working properly. If your brain cells go too long without oxygen, they die. If enough brain cells in an area die, damage becomes permanent, and you may lose the abilities that area of the brain once controlled. That’s why time is critical in treating a stroke.

WAM: How does stress accelerate cardiovascular disease in a way that puts the brain at risk?
Dr. Cho: Stress increases blood pressure, increases inflammation and can cause us to eat poorly, increase bad habits (like drinking alcohol and smoking) and cause irregular sleep patterns – all of which are bad for the heart and contribute to risk factors for conditions like heart disease.

Tips for destressing include:
· Exercising regularly
· Meditation, deep breathing and yoga
· Calming apps or music
· Focusing on one task at a time
· Bringing soft colors and plants into your space
· Limiting alcohol intake

WAM: What tips or habits should everyone take away from this conversation to ensure their heart health can protect their brain health?
Dr. Cho: Again, what’s good for the heart is good for the brain, so:

1. Exercise regularly (5 times a week for 30 minutes a day).
2. Do not smoke.
3. Eat a Mediterranean diet.
4. Know your numbers and discuss them with your doctor. Blood pressure, cholesterol, fasting, glucose levels, and body mass index are key.