Sidonie Ibrikji, MD is a Vascular Neurologist at the Cleveland Clinic Cerebrovascular Center. In this illuminating conversation, we explore the vital connection between cardiovascular and cognitive health, and learn why keeping your heart healthy could be the key to maintaining a sharp mind as you age.
Read the Q&A with Dr. Ibrikji below.
WAM: Many people don’t realize that heart health and brain health are connected. Could you explain in simple terms what science tells us about this connection?
Dr. Ibrikji: Heart and brain health are deeply connected because both rely on a healthy vascular system. The brain needs a continuous supply of oxygen and nutrients, which are delivered by the cardiovascular system. Conditions like high blood pressure, atrial fibrillation, and high cholesterol can lead to stroke, cognitive impairment, and even dementia. Essentially, what’s good for the heart—controlling risk factors like hypertension, diabetes, and cholesterol—is also good for the brain.
WAM: We know high blood pressure is a risk factor for cognitive decline. Why is that, and at what age should people start monitoring their blood pressure to protect their brain health?
Dr. Ibrikji: High blood pressure is a major risk factor for cognitive decline because it damages the small blood vessels in the brain over time, leading to microvascular disease, silent strokes, and white matter changes that contribute to vascular dementia. The process can start decades before symptoms appear, so monitoring blood pressure should ideally begin in young adulthood. By midlife (40s and 50s), keeping blood pressure within an optimal range (<130/80 mmHg) becomes especially critical for long-term brain health.
WAM: How does exercise benefit both heart and brain health simultaneously? Are there specific types of exercise that offer the greatest protection?
Dr. Ibrikji: Exercise benefits both the heart and brain by improving cardiovascular function, reducing inflammation, and enhancing blood flow to the brain. It also promotes neuroplasticity and reduces the risk of conditions like stroke and dementia. The best exercises are those that combine aerobic activity (such as brisk walking, cycling, or swimming) with resistance training (like weightlifting or bodyweight exercises). The goal is at least 150 minutes per week of moderate-intensity aerobic exercise, plus strength training twice a week.
WAM: What role does cholesterol play in brain health, and how do medications like statins factor into protecting against cognitive decline?
Dr. Ibrikji: Cholesterol plays a complex role in brain health. While cholesterol is essential for neuronal function, excess LDL cholesterol contributes to atherosclerosis, increasing stroke risk. Statins lower LDL and reduce cardiovascular events, but there has been some debate about whether they impact cognition. Current evidence suggests that statins do not cause cognitive decline and may even have a protective effect by preventing stroke and vascular dementia in high-risk individuals.
WAM: For someone who has already been diagnosed with heart disease, what steps can they take to protect their cognitive health going forward?
Dr. Ibrikji: For individuals with heart disease, protecting cognitive health involves aggressive vascular risk factor control. This means maintaining optimal blood pressure, cholesterol, and glucose levels, adhering to a heart-healthy diet (such as the Mediterranean or DASH diet), staying physically active, and managing sleep and stress. If they have atrial fibrillation, anticoagulation is crucial to prevent embolic strokes. Additionally, cognitive engagement and social interaction can help maintain brain function.