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Cardiovascular and Brain Health

A summary of the evidence denoting that good cardiovascular health helps brain and mental health.

Linda Keddington, DNP, APRN

Dec 6, 2025

What the Evidence Shows

A large and growing body of evidence shows that better cardiovascular health strongly protects brain health—reducing the risk of stroke, dementia, depression, and age-related cognitive decline. These benefits appear to arise through both vascular pathways (improved blood flow, reduced small-vessel disease) and neurodegenerative pathways (reduced neuronal injury and slower brain aging).


Cardiovascular Health and Risk of Stroke, Dementia, and Depression

In a prospective study of more than 316,000 middle-aged adults, people with poor cardiovascular health had over twice the risk of developing a composite outcome of stroke, dementia, or late-life depression compared with those with optimal cardiovascular health (HR 2.11; 95% CI, 1.88–2.36). This finding was also replicated in an independent U.S. cohort.¹


Cardiovascular Health and Dementia

Better cardiovascular health in older adults is consistently associated with:

  • Lower dementia incidence

  • Slower cognitive decline

  • Incremental benefit with each additional cardiovascular health metric at optimal status²˒³

Midlife cardiovascular health appears especially critical. One study demonstrated that cardiovascular health measured seven years before baseline predicted dementia risk, while more recent measurements did not—suggesting early-life prevention windows.⁴


Cardiovascular Health and Depression

Cardiovascular health also has important mental health implications:

  • Older adults with better cardiovascular health show a substantially lower risk of clinically relevant depressive symptoms.⁹

  • Higher midlife cardiorespiratory fitness predicts:

    • Lower incidence of depression later in life

    • Lower cardiovascular mortality among those who develop depression¹⁰


Mechanisms: Protecting the Brain Through Vascular and Neurodegenerative Pathways

Cardiovascular health supports the brain through several interconnected biological mechanisms:

  • Less white matter hyperintensity progression, indicating reduced small-vessel disease⁵

  • Reduced brain atrophy and a “younger” brain age on neuroimaging⁵˒⁶

  • Lower circulating neurofilament light chain (NfL)—a biomarker for neuronal injury—in adults with healthier cardiovascular profiles, even after accounting for vascular pathology⁷


The American Heart Association estimates that up to 35% of dementia cases could be prevented by eliminating modifiable cardiovascular risk factors such as hypertension, diabetes, obesity, physical inactivity, and smoking.⁸


Clinical Implications

Optimizing cardiovascular health is a primary prevention strategy for brain health. The American Heart Association recommends following Life’s Essential 8—a comprehensive framework targeting:

  • Blood pressure

  • Glucose

  • Cholesterol

  • Body mass index

  • Smoking

  • Physical activity

  • Diet quality

  • Sleep

Individuals with genetic susceptibility to metabolic disease show accelerated vascular brain aging, but this effect is attenuated in those with favorable cardiovascular health—highlighting the potential for healthy behaviors to blunt genetic risk.⁶


Multi-domain interventions that target cardiovascular risk factors show promise in slowing cognitive decline in at-risk older adults. Declining dementia incidence in several countries is attributed partly to more aggressive cardiovascular risk factor control.⁸


Information for the Public

The American Health Association's Life’s Essential 8 (and its predecessor, Life’s Simple 7) provides an easy-to-use, evidence-based tool for evaluating and improving cardiovascular health with direct benefits for brain aging, cognitive function, and mental health.


Disclaimer

This content is for informational purposes only. It is not intended to replace professional medical or mental health advice, diagnosis, or treatment from your healthcare provider. Always consult your physician or qualified health provider with any questions you may have regarding a medical or mental health condition. Use of this content does not establish a patient-provider relationship.


References:

  1. Clocchiatti-Tuozzo, S., Rivier, C. A., Renedo, D., et al. (2024). Life's Essential 8 and poor brain health outcomes in middle-aged adults. Neurology, 103(10), e209990. doi:10.1212/WNL.0000000000209990

  2. Samieri, C., Perier, M. C., Gaye, B., et al. (2018). Association of cardiovascular health level in older age with cognitive decline and incident dementia. JAMA, 320(7), 657–664. doi:10.1001/jama.2018.11499

  3. Samieri, C., Perier, M. C., Gaye, B., et al. (2018). Association of cardiovascular health level in older age with cognitive decline and incident dementia. JAMA, 320(7), 657–664. doi:10.1001/jama.2018.11499

  4. Pase, M. P., Beiser, A., Enserro, D., et al. (2016). Association of ideal cardiovascular health with vascular brain injury and incident dementia. Stroke, 47(5), 1201–1206. doi:10.1161/STROKEAHA.115.012608

  5. Huang, H., Wang, J., Dunk, M. M., et al. (2024). Association of cardiovascular health with brain age estimated using machine learning methods in middle-aged and older adults. Neurology, 103(2), e209530. doi:10.1212/WNL.0000000000209530

  6. Li, Y., Laukka, E. J., Dekhtyar, S., et al. (2023). Association between behavioral, biological, and genetic markers of cardiovascular health and MRI markers of brain aging: A cohort study. Neurology, 100(1), e38–e48. doi:10.1212/WNL.0000000000201346

  7. Dhana, A., DeCarli, C. S., Dhana, K., et al. (2025). Cardiovascular health and biomarkers of neurodegenerative disease in older adults. JAMA Network Open, 8(3), e250527. doi:10.1001/jamanetworkopen.2025.0527

  8. Lazar, R. M., Howard, V. J., Kernan, W. N., et al. (2021). A primary care agenda for brain health: A scientific statement from the American Heart Association. Stroke, 52(6), e295–e308. doi:10.1161/STR.0000000000000367

  9. van Sloten, T. T., Valentin, E., Climie, R. E., et al. (2023). Association of cardiovascular health with risk of clinically relevant depressive symptoms. JAMA Psychiatry, 80(4), 342–349. doi:10.1001/jamapsychiatry.2022.5056

  10. Willis, B. L., Leonard, D., Barlow, C. E., et al. (2018). Association of midlife cardiorespiratory fitness with incident depression and cardiovascular death after depression in later life. JAMA Psychiatry, 75(9), 911–917. doi:10.1001/jamapsychiatry.2018.1467

  11. Gorelick, P. B., Furie, K. L., Iadecola, C., et al. (2017). Defining optimal brain health in adults: A presidential advisory from the American Heart Association/American Stroke Association. Stroke, 48(10), e284–e303. doi:10.1161/STR.0000000000000148

  12. Testai, F. D., Gorelick, P. B., Chuang, P. Y., et al. (2024). Cardiac contributions to brain health: A scientific statement from the American Heart Association. Stroke, 55(12), e425–e438. doi:10.1161/STR.0000000000000476

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