A novel approach to the prevention and management of cardiovascular diseases: targeting brain–heart axis

Fig.1. The brain–heart axis consists of key autonomic nervous networks and conduction systems. In the coronal plane of the brain, the autonomic nervous networks of the brain–heart axis are illustrated. The efferent routes start from the medial prefrontal cortex and insular cortex and conclude at the myocardial cells and artery epithelial cells. The afferent routes begin with input from chemoreceptors and baroreceptors and eventually reach the insular cortex. DVN dorsal vagal nucleus, NTS nucleus tractus solitarius, PVN paraventricular nucleus, RVLM rostral ventrolateral medulla

Fig.2. Common brain injuries and the CVDs they cause. The diagram shows that brain injuries caused by stroke, stress, PTSD, etc., result in arrhythmias, heart failure, coronary artery damage, Takotsubo syndrome, and hypertension. PTSD: post-traumatic stress disorder

Fig.3. The four mechanisms of the brain–heart axis can be illustrated as follows: A The impact of ANS dysregulation on cardiac function, resulting in changes in myocardial contractility. B The mechanisms by which endocrine system dysfunction affects the cardiovascular system. The two classical pathways, HPA and RAAS, are shown. C Brain injury leading to localized and systemic inflammation. D Brain injury causing gastrointestinal dysfunction, dysbiosis of the gut microbiota, and bacterial translocation into the bloodstream, leading to distal inflammatory immune responses and further brain damage. AC adenylate cyclase, Ach acetylcholine, ACTH Adrenocorticotropic Hormone, AIS acute ischemic stroke, Akt protein kinase B, β1-R beta1-adrenergic receptor, β2-R beta2-adrenergic receptor, cAMP cyclic adenosine monophosphate, CRH corticotropin releasing hormone, FOXO forkhead box O, HPA hypothalamic-pituitary axis, ICAM intercellular adhesion molecule, IK-Ach acetylcholine-sensitive K+channel, IL-1β interleukin-1β, IL-6 interleukin-6, M2-R M2 muscarinic receptors, PKA protein kinase A, RAAS renin–angiotensin–aldosterone system, TNF-α tumor necrosis factor, VCAM vascular cell adhesion molecule

Fig.4. In the brain–heart axis, the primary brain regions that regulate cardiovascular diseases are of significant importance. These regions can be visualized in a schematic diagram of the brain. M1 cerebral cortex, NTS nucleus of the solitary tract, OVLT organum vasculosum laminae terminalis, PVN paraventricular nucleus, RVLM rostral ventrolateral medulla, SFO Subfornical organ