Cognitive decline, mental health and heart disease are all shaped by the deep links between heart and brain – with major implications for diagnoses and treatment
You’re lying on a hospital gurney, waiting for the anaesthesiologist to send you under so you can be taken into theatre and the operation can begin. Naturally, you’re nervous. But mixed with the quiet buzz of surgeons moving about is the soothing sound of piano, as classical music plays in the background, calming you, note by note.
You won’t hear it, but the music will deliver its biggest benefits once you are unconscious – lowering your blood pressure, heart rate and respiratory rate and leading to fewer complications and dramatically less pain when you wake up. The idea of seeing such impressive results from such a small intervention might sound fanciful, but those were the findings of “It finally provides scientific proof for something heart doctors have noticed for years: the mind can influence the heart, even during major surgery. Showing that a simple intervention like music can change physiological responses supports how deeply the heart and mind are connected,” saysThat the heart and mind are linked has been known for decades, of course. These findings, though, are part of a wave of research revealing that the connection is deeper and more powerful than was previously understood – and that it is something we can all tap into to boost our well-being. “We’re beginning to understand that the brain and the heart are part of one integrated system. And that changes how we think about prevention, treatment – really everything,” says Mitchell Elkind at the American Heart Association, who won aDoctors have long noticed that when the heart is sick, often the brain isn’t far behind, and vice versa. Depression substantiallyinformation about blood pressure, the rhythm of the heartbeat and strain on the organ back to the brain – largely through the vagus nerve – where it is integrated in areas that regulate bodily state.“The mechanisms by which the heart and brain communicate in dysfunction are many,” says Elkind. “Some degenerative disorders, like Parkinson’s disease, are an example of how the brain and heart talk to each other. We generally think of Parkinson’s disease as a disease of the brain, but it turns out the nerve degeneration actually affects the heart as one of its first targets, and the brain involvement may come later.” In recent years, the neural components of the axis have been pieced together, showing that people with mental health conditions, such as, have significantly reduced activity in their vagus nerve, meaning their parasympathetic nervous system – which promotes rest and relaxation – is weaker. They are also less attuned to the signals from the heart. “Every time your heart beats, it sends a signal to the brain indicating how fast and strong the heart is beating,” says, who researches brain-body interactions at University College London. “The brain can then use that signal to regulate the heart, so the system is fundamentally bidirectional.” The heart-brain axis forms a major part of interoception, the sense that allows the brain to interpret signals from the body, like hunger or the sensation of anxiety. This close relationship means there is potential to diagnose conditions that affect both the heart and brain more easily., a concert pianist and researcher in computational music perception at King’s College London, is one person working in this area. Since childhood, she had lived with an arrhythmia. As an adult, she had two ablations, which remedied her condition and sparked a fascination with fusing her expertise in studying musical structures with cardiology. Luckily, her cardiologist was interested in the heart-brain axis, too.from inside the hearts of people fitted with pacemakers while they listened to live concerts. Music is the “perfect thing to study heart-brain interaction because it affects the brain and the heart and allows us to probe both”, says Chew. “The heart-brain axis is what allows us to experience music through perception, but also through bodily reactions like chills down the spine or having the heart rate increase.” Earlier this year, Chew was part of a team that published research indicating that music can be an accessible way to detect hypertension., she knew that high blood pressure significantly dampens the body’s reactivity to music. “In hypertension, the blood vessels might be stiffer,” she says. “So the cardiovascular system is less able to respond to the brain’s neural activity when listening to music.”that, because reactions to musical features like tempo and volume variations exaggerate the cardiovascular differences in people with hypertension, playing music to them while monitoring their cardiovascular signals via electrocardiograms helped to identify the condition more reliably, increasing accuracy by around 10 per cent in a relatively short amount of time compared withhypertensive warnings. Because so many people wear wearable tech like smartwatches, and because many earbuds have biosensors, Chew says data could be collected to give people an early warning to visit their doctor because they might have the condition.she has been part of, she is also hopeful that music could be used as a treatment: using details about a person’s autonomic nervous system, which controls unconscious bodily functions like breathing and heartbeat, it could be personalised to raise or lower a person’s blood pressure. Both of these ideas are in their early days, and clinical trials are needed to test their efficacy in large numbers of people in real-world settings, but Chew is optimistic. “It’s a long process, but the technology is here,” she says.“With an ageing population, we are going to see more and more patients with heart failure and dementia,” he says. “So, I wanted to look for insights into both conditions to find a treatment that can help to prevent or treat either, and prolong the number of years lived in good health.” Research on the heart-brain axis has broadened in recent years, he says, moving from looking at issues linked solely with the autonomic nervous system – like the modulation of blood pressure and response to stress – to discovering links between the heart and the brain via blood vessels. Because the two organs are connected via a vascular network, issues with the heart can lead to brain problems. Stiffening of arteries can not only cause vascular damage in the heart, for instance, but also harm tiny blood vessels in the brain, which mayThis insight has led Masci to search for a new, easy-to-scale measure linking the health of the brain and the cardiovascular system. Currently, many people with hypertension are undiagnosed and untreated, and the condition is a risk factor for both heart failure and dementia. Masci and his colleagues developed a new way to detect arterial elastance, namely how hard your heart has to push to get blood into the body. This measure is tightly linked with hypertension and could be tracked via wearable technology, rather than current expensive methods. The team’s methods of detecting the metric, which make use of data from the UK Biobank study, are currently submitted for publication. Arterial elastance is far more comprehensive than simply reading someone’s blood pressure to detect hypertension, says Masci. While a person’s blood pressure could be brought down with medication, other issues highlighted by arterial elastance, like the risk of damage to the brain, could remain untreated, because arterial elastance remains high. Finding ways to detect arterial elastance at scale, then, is crucial for a more integrated understanding of heart and brain health.As promising avenues for enhanced diagnosis using the heart-brain axis are opening up, so, too, are new treatment options. Elkind says that the wiring between the heart and brain can become disrupted due to things like inflammation, degeneration, hormonal changes or underlying common genetic mutations. But some pharmaceutical drugs already on shelves may partly remedy faulty connections. “A lot of the medications that we use to treat mental health disorders can influence the neurotransmitters and the nerves that talk back and forth between the heart and the brain,” he says.suggests that antidepressants may affect the vagus nerve, altering the autonomic signals that regulate heart rate and stress responses as mood symptoms improve. “I could imagine that, in the future, we treat depression in patients with heart failure in order to improve their cardiac outcomes,” he says.showing how reduced interoceptive accuracy can contribute to poor decision-making. A potential solution, he says, lies in beta blockers, which are traditionally prescribed to manage hypertension and anxiety. Researchers have previously noticed how these drugs can also“The heart-brain connection, if mis-wired, can adversely affect your ability to make sensible decisions,” he says. “So, for those who struggle with impulse control and make poor financial decisions, beta blockers seem to help.”The medication may also be useful in other instances. Following a stroke, for example, people can become unusually hyperactive or aggressive, sometimes even threatening loved ones, says Elkind. “A beta blocker can help to, again, take that away. It lowers the heart rate, it lowers the blood pressure. But at the same time, it also has an effect on the mood and the brain.” When the heart isn’t shouting, the brain can listen more clearly. The mass adoption of GLP-1 agonist drugs like Ozempic and Wegovy has also had unexpected implications for the heart-brain axis. These medications normally lead to significant weight loss, in turn reducing the risk of cardiovascular disease. But a study published last year showed that weight losslow-grade inflammation, so, over time, they prevent damage to the important blood vessels in the heart-brain connection and help blood flow between the two organs. This reduces strain on the heart, as it receives enough blood to pump around the body, and so the risk of heart disease drops. In the future, everyone might take a GLP-1 for their “life-prolonging effects”, he says. “Whether healthy, normal‑weight people will take them routinely depends on long‑term safety, cost and need, but the field is definitely moving in that direction. Emerging research suggests they may offer benefits well beyond weight control, including metabolic stabilisation, anti‑inflammatory effects, improvements in emotional well‑being and even potential cognitive enhancements.”a common form of interoceptive training in which people are asked to count their heartbeat without touching their pulse and then compare their perception with a visual readout or a tone synced to their actual heart rhythm. Over time, that comparison allowed them to recognise which internal sensations reliably signal a heartbeat, improving emotional regulation and helping them make more rational decisions., meanwhile, found that volunteers who underwent training for one week improved their interoceptive accuracy, felt less “baseline” anxiety and made smarter decisions in a simulated gambling task. More recently,in 2023 showed that interoceptive training significantly boosted emotional regulation and emotional self-awareness. Structural changes in the brain were discovered, with imaging scans showingSuch training can make a huge difference for people with neurological differences, too, says Garfinkel. “I’ve had emails from people with autism and ADHD saying how even learning about the word ‘interoception’ changed their life,” she says. “There was one individual who believed he was a psychopath because he didn’t know if he was feeling the right things. But, actually, we’re able to say that maybe he just didn’t have the insight into his body’s signals.”a gambling task in which not only did having a heart rate that responded more flexibly over the course of the game predict good decision-making, but also cardiac activity was linked with many aspects of cognitive performance. Those with greater activation of their parasympathetic system – responsible for slowing down a rapid heartbeat – were found to be more flexible thinkers, have stronger working memory scores and to be more effective planners.at Sapienza University of Rome in Italy. “People whose hearts could adapt more efficiently also appeared to have a brain that adapted more efficiently. It shows cognition doesn’t just come from the brain – it’s more of a dynamic dialogue between brain and body. One way to think about it is that the heart and brain operate as part of a coordinated system. A flexible cardiovascular system may provide the physiological stability that allows the brain to remain responsive, focused and capable of adjusting behaviour when situations change.”Marie D. De Jesus/Houston Chronicle via Getty Imagesfrom last year used electrodes to stimulate the vagus nerve and showed that engaging the parasympathetic system in this way creates a calmer physiological state. You can even try a low-tech version of the same mechanism at home: a breathing technique used in meditation called bhramari pranayama, or “humming bee breath”, produces a gentle buzzing sound during exhalation. “This simple humming activates the parasympathetic nervous system, which helps lower heart rate, increases heart rate variability and lowers stress,” says Garfinkel. With this system Harnessing the power of these insights holds huge promise. “We’re moving into a new generation of science where we look at the whole system together,” says Garfinkel. Cardiologists and neurologists will have to start working together, says Viswanathan, as the heart and brain can no longer be considered in isolation. “We now understand that if you look after the heart, you look after the brain, and vice versa,” he says. For centuries, we have asked whether to trust the heart or the head. Now, the better question is why we ever separated them in the first place.
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