New CMAJ Guideline Adopts Holistic Approach to Brain and Heart Health
The Canadian Medical Association Journal (CMAJ) has published a new clinical practice guideline that adopts a holistic approach by integrating neurologic and mental health evidence with cardiovascular disease guidance. This initiative addresses the overlap and shared risk factors between brain and heart conditions.
The new clinical practice guideline from the CMAJ adopts a holistic approach, integrating neurologic and mental health evidence with cardiovascular disease guidance to address the overlap and shared risk factors between brain and heart conditions.
Why a Holistic Approach?
Existing guidelines for cardiac, neurologic, and mental health conditions often utilize disease-specific approaches, despite the frequent co-occurrence of cardiovascular conditions with other diseases. Dr. Jodi Edwards, lead author and director of the Brain and Heart Nexus Research Program, stated that the guideline was developed due to the recognized connections between brain and heart diseases as a source of chronic illness in aging populations. These conditions often share risk factors, pathophysiological processes, and genetic links, leading to their frequent co-occurrence and reciprocal increased risks.
Developed Through Collaboration
Developed through the Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) process, which included patient partners, the guideline offers evidence-based guidance. It is intended for primary care professionals, subspecialists, allied health teams, and patients with cardiovascular risk factors. The guideline also incorporates sex and gender considerations into its recommendations.
Key Recommendations
The guideline presents 11 recommendations, which include:
- Screening individuals with atrial fibrillation for cognitive decline risk.
- Screening for depression in patients with coronary artery disease and providing evidence-based treatment if detected.
- Initiating intensive blood pressure lowering in individuals at increased cardiovascular risk to reduce cognitive impairment risk.
- Starting intensified cholesterol lowering to prevent heart attack in people with a history of stroke, and to prevent stroke in people following a myocardial infarction.
- Routinely offering influenza, pneumococcus, and shingles vaccination, especially to individuals aged 65 years and older, to help prevent stroke, heart attack, and vascular cognitive impairment.
- Utilizing patient decision aids to facilitate guideline implementation.
Expert Perspectives and Implementation
Dr. Peter Liu, a cardiologist at the University of Ottawa Heart Institute and chair of the Brain–Heart Interconnectome, noted that the recommendations acknowledge the relationship between heart and brain diseases and advocate for comprehensive patient screening and treatment. The development team has created implementation tools for clinicians and patients, such as infographics and decision aids, available at www.ottawaheart.ca. Dr. Sheldon Tobe, a nephrologist and co-chair of C-CHANGE, stated that the guideline aims to assist healthcare professionals in managing patients with co-occurring brain and heart diseases.
Funding Recognition
The University of Ottawa Brain–Heart Interconnectome research program received funding from the Canada First Research Excellence Fund for this initiative.