Heart and Brain: Linking Obesity-Related Inflammation, Cardiovascular Disease and Cognitive Function

The heart and brain are interconnected, and risk factors that impact the heart can negatively affect the brain and cognition. Among the underlying features that foster both poor brain health and poor heart health are obesity, diabetes, physical inactivity and low sleep quality. Obesity and type 2 diabetes are associated with an increased likelihood of cognitive impairment and dementia. Further, obesity is a causal factor in obstructive sleep apnea, leading to intermittent hypoxemia, neuroinflammation and cognitive dysfunction. Cerebrovascular disease with reduced cerebral blood flow brings on stroke and elevates dementia risk. Like cardiovascular disease, cerebrovascular disease is also accelerated in the setting of obesity, likely through the same mechanisms involving endothelial dysfunction and damage to macrovasculature and microvasculature from hypertension, dyslipidemia and inflammation. Obesity is considered a risk factor for recurrent stroke. The protracted low-grade chronic elevation of inflammatory markers found with excess adiposity leads to oxidative stress and promotes both endothelial dysfunction and a pro-thrombotic state. Greater loss of brain volume has been documented in middle-aged and older adults with obesity compared with young adults with obesity. Obesity poses a threat to the cardiovascular and cerebrovascular health and well-being of individuals worldwide. Unfortunately, treatments directed at reducing caloric intake are of limited effectiveness. This review will focus on the latest research into the link between excess adipose tissue and cardiac and brain health, with attention to dietary and lifestyle interventions that may be protective of the integrity and function of the vasculature and brain.