Heart health: the vascular side of brain health

Why the heart and brain are one system

The brain receives about a fifth of the heart's output and has no energy reserve of its own. Anything that stiffens or narrows arteries, raises pressure in small vessels, or lets blood sugar and cholesterol damage their lining shows up in the brain as white-matter damage, small strokes and slower thinking. Dementia in older people is usually mixed: Alzheimer's changes and vascular changes together. That is why the vascular factors on this page account for so much of the preventable risk.

Blood pressure

Hypertension in midlife is the best-established vascular risk factor for dementia. The Lancet Commission recommends keeping systolic pressure at or below 130 mmHg from around age 40. The SPRINT MIND trial found that intensive control (target below 120 mmHg) reduced the risk of mild cognitive impairment compared with a 140 mmHg target.

A July 2026 analysis of the ARIC study in Neurology followed more than 11,000 adults for over 25 years and found that midlife hypertension raised dementia risk by roughly 20 to 35 percent across every level of Alzheimer's genetic risk, with no difference between low-, medium- and high-risk groups. Treating blood pressure, in other words, helps APOE ε4 carriers as much as anyone else. A May 2026 study in the same journal linked greater 24-hour blood-pressure variability to worse cognition and more structural brain change.

Cholesterol and lipoprotein(a)

• LDL cholesterol. High LDL in midlife was added to the Commission's list of modifiable risk factors in 2024. Statins have not been shown to prevent dementia in trials, but lowering LDL protects against the strokes and vascular damage that contribute to it.
• Lipoprotein(a). Lp(a) is a genetically determined cholesterol particle and a causal factor for heart disease that diet does not change. A November 2025 study in the European Heart Journal of 539,478 people in Copenhagen and the UK Biobank found that Lp(a) levels were not associated with Alzheimer's disease or vascular dementia on a continuous scale, though very high levels or small isoforms could not be ruled out as risks. For now, Lp(a) matters for the heart more than for the brain, and drugs to lower it are in trials.
• Genetic coronary risk. An April 2025 study in Circulation of 365,782 UK Biobank participants found that a polygenic risk score for coronary artery disease modestly raised dementia risk, mostly vascular dementia, and that people with high genetic risk but a healthy lifestyle score had about 30 percent lower risk than those with an unhealthy one. Lifestyle added to genetics rather than cancelling it.

The measures worth tracking

What to do

1. Know your blood pressure, and treat it to target. This has the strongest evidence of anything on this site.
2. Have lipids measured, including lipoprotein(a) once, and agree an LDL target with your clinician.
3. Keep blood sugar in range; diabetes prevention is brain prevention.
4. Treat atrial fibrillation and hearing loss when found; both are easy to miss and both carry dementia risk.
5. Move daily. Aerobic activity improves blood flow to the brain and is part of every successful multidomain trial.