This transcript has been edited for clarity. Recorded November 9, 2025
Robert A. Harrington, MD: Hi. I’m Bob Harrington from Weill Cornell Medicine in New York City, and I’m here at the American Heart Association Scientific Sessions in New Orleans.
It’s been a great meeting and a large amount of the science that’s presented is not just on heart health, which is what you think about at the American Heart. You also have to remember that the American Heart Association is the American Stroke Association as well.
There’s a large amount of science here on stroke and cerebral vascular disease, and what’s pretty apparent as you walk around the sessions or you look at the posters, is that there’s this intersection between heart health and brain health. In fact, one of the comments I’ve heard in several sessions that I’ve been at over the last couple of days is that heart health is brain health, and brain health is heart health.
I thought we’d use the time here in New Orleans to talk to one of my colleagues who is a neurologist and who’s playing a leading role for the American Heart Association in understanding brain health.
I’m really pleased to be joined by my good friend and colleague, Dr Mitch Elkind. Mitch, thanks for joining us here on Medscape Cardiology and theheart.org.
Mitchell S. Elkind, MD, MS: Thank you, Bob, for having me. I really appreciate it.
AHA’s New Focus on Brain Health
Harrington: Mitch is the Chief Science Officer for Brain Health and Stroke for the American Heart Association (AHA). That was a new job created as people began to understand this connection.
Elkind: That’s absolutely correct. I’m the first person to hold that position, and I’m really excited about it.
Harrington: He’s also a stroke neurologist and professor emeritus at Columbia University in New York City.
The other thing is that Mitch and I are very close because we served as presidents of the American Heart Association, me and then you.
Elkind: That’s right. I followed in your footsteps.
Harrington: We had a great time during those couple of years, despite the toughness of the time, which was COVID.
I opened with this notion that heart health is brain health and brain health is heart health. As I walked around the sessions talking to people, they mean that the risk factors — hypertension, smoking, bad diets, lack of physical activity, diabetes, obesity — all of the things we think about as Life’s Essential 8 for the heart are also Life’s Essential 8 for the brain.
Elkind: We certainly say that what’s good for the heart is good for the brain, but I think it is really important for people to remember that what’s good for the brain is also good for the heart. It is a two-way street.
Harrington: I didn’t say that you were just the stroke science officer. It is brain health. The AHA is doing things other than just stroke care.
Elkind: That’s right. We’re launching a new initiative around brain health. We’ve always done stroke, pretty much throughout the entire history of the AHA. Now, we’re beginning to go beyond stroke to conditions that we know are connected to the vascular system and the heart, so things like cognitive aging and dementia. We know the same risk factors for heart disease and stroke are also risk factors for dementia, for example.
There are other connections between the blood vessels and brain disorders. Think about migraine, which is also a risk factor for stroke. It may even be a risk factor for heart disease, some research suggests.
Harrington: Do you mean more than like atrial septal defects and the risk of stroke in people with atrial septal defects have some increased risk of migraines?
Elkind: Yes. Well, the mechanisms are not entirely clear for how migraine may contribute to heart disease per se, but we do see in observational studies an increased risk of cardiac events as well in people with migraine. It could be differences in behavior due to the migraine. It could be other things, too, or confounding factors. There seems to be an association that we need to tease out with further research.
Things like epilepsy. The leading cause of epilepsy in adults is really cardiovascular disease and stroke, sometimes even silent or micro-infarcts. That’s a condition that overlaps as well.
Harrington: That we might not initially think about.
Elkind: Exactly. Frankly, even things like traumatic brain injury. An injury to the brain, whether it’s a stroke or traumatic injury, may lead to similar kinds of secondary effects. The accelerated neurodegeneration that we are beginning to see or recognize in stroke patients seems to also happen after traumatic brain injury. There’s a large amount of overlap there.
Harrington: When we think about some of the neurodegenerative diseases you started mentioning, like Parkinson’s, is there a connection with the heart?
Elkind: Well, there’s certainly a connection with the vascular system. With Parkinson’s, I think the story may be a little bit different. One of the interesting things is that one of the earliest manifestations of Parkinson’s is actually degeneration of the nerves that are affecting the heart, the autonomic nervous system to the heart.
We think of Parkinson’s as causing tremor, but it also causes autonomic degeneration, right? One of the earliest things you can pick up is abnormalities in innervation of the heart. There’s a connection there, but I think that’s better worked out or further advanced in the study of Alzheimer’s disease, for example, which is more common than Parkinson’s.
Dementia, Alzheimer’s, and Blood Pressure
Harrington: Well, let’s talk about Alzheimer’s, because you very specifically said cognitive decline. You didn’t say Alzheimer’s. You’re not making them the same.
Elkind: Well, they’re really not the same because in very few people — if you look pathologically after they die — do you find only Alzheimer’s disease. Maybe 5% or so will have only Alzheimer’s disease. Most of the time in somebody who dies with dementia, you’ll discover the pathology of Alzheimer’s, you’ll discover small infarcts or large infarcts. You’ll see Lewy bodies and other types of misfolded proteins and so forth. Maybe degeneration from alcohol or other toxins.
Most of the time, dementia is caused by an overlap of different conditions, so it’s hard sometimes to tease out the specific pathology that’s causing it. To the extent that we can, yes, it seems like the vascular risk factors contribute to the Alzheimer’s component of it.
Harrington: As we think about Life’s Essential 8 and the risk factors for heart disease, particularly coronary heart disease, we think about the effect of things like diabetes on the brain.
Elkind: Diabetes is a risk factor for small vessel disease, certainly. I think you probably see that in the heart.
Harrington: We do.
Elkind: We see that in the brain to a large extent. We know that small vessel disease of the brain can be an important contributor to dementia. Probably the biggest risk factor, though, is high blood pressure, which also causes small vessel disease. You’re probably aware that, in the most recent joint guidelines for the prevention and management of hypertension that came out from the American Heart Association and the American College of Cardiology in August of this year, for the very first time, they gave the highest level of evidence to treatment of blood pressure to prevent cognitive decline in dementia.
Harrington: That was an important observation that they put out there, and it made highlights on the news.
Elkind: It’s gotten a large amount of attention, and it’s based on high-level clinical trial evidence. That, I think, is the first kind of definitive proof of how treating a vascular risk factor can mitigate cognitive decline and dementia.
Are GLP-1s a Neurologic Drug?
Harrington: One of the areas in cardiovascular medicine that has gotten so much attention over the last couple of years is obesity and the treatment thereof. And in particular with the GLP-1s and associated other agents, not only losing weight, but markedly reducing cardiovascular risk. Do we see the same with the brain?
Elkind: Well, we don’t have any published trials that have focused solely on that as a primary outcome. In secondary analyses of the cardiovascular data, there is suggestion of that as well. Certainly, stroke, and we’re just beginning to see emerging data around dementia as well. We need dedicated trials to show that.
Harrington: Are we going to have them? Do you know if they’re being planned?
Elkind: I don’t know that there are any already on the way, but I certainly think it needs to be done. Neurology tends to follow by about 10-15 years behind cardiology.
Harrington: You and I have talked about this. The fibrinolysis story is a good example of this.
Elkind: Another major risk factor, of course, is atrial fibrillation, which can cause strokes. But there seems to be a connection between AFib and dementia — sometimes even outside of people having clinical strokes — which suggests that subclinical or small infarcts may also play a role. Of course, with AFib, you also have a decrement in perfusion to some extent, so that may play a role.
The same kind of phenomenon, I think, exists in heart failure where patients with heart failure, at least in advanced heart failure, have a 30%-40% reduction in perfusion of the brain. We do see cognitive problems in patients with severe heart failure.
Harrington: This morning, I was at a session on the metabolic abnormalities around atrial fibrillation. There was a state-of-the-art talk, and I asked, given all the modifiable risk factors, the things we’ve just talked about, Life’s Essential 8, if you were to concentrate on one, just one, what would you concentrate on to lower the risk of atrial fibrillation? He said weight loss. He said weight loss ties to other things, but you get such a profound benefit of reducing the risk of atrial fibrillation with weight loss. He said, that’s where you need to go first.
Now, it pulls along other things like diabetes, etc., but how about for the brain? Is weight loss the most important risk factor for brain health?
Elkind: I think most people would say no — not that it’s not important.
Harrington: They’d say hypertension.
Elkind: They’d say hypertension. Probably, as far as behavioral factors go, it’s going to be exercise. I mean, there’s a fairly robust evidence base about the benefits of exercise for brain health. Again, it’s hard sometimes to prove these in the kinds of randomized, large-scale trials that you do.
Exercise, too, has so many benefits on blood pressure, weight, and AFib. The other major one, frankly, is sleep, right? We know that, to some extent, clearing the brain of amyloid and other toxins is dependent on the glymphatic system.
That’s your brain’s way of clearing toxins, just like the lymphatic system in the peripheral body. Getting adequate sleep is what allows that system to function. It only works when you’re sleeping, and in certain stages of sleep, actually.
Harrington: It has to be not just sleep, but quality of sleep.
Elkind: It’s really interesting because it depends on you sleeping and having the right sleep stages, but also cardiac function is kind of a passive system. The heart has to pump adequately for the glymphatic system to work. It’s a great example, frankly, of that connect between the heart and the brain.
Harrington: We were talking about GLP-1s. The connection between the heart and the brain or maybe the gut and the brain with regard to the GLP-1s. Want to pull that into it?
Elkind: I think the GLP-1s are really interesting because we think of them as this metabolic gut enzyme and so forth, but we’ve been seeing effects on the brain in terms of substance abuse, right? Gambling and addiction. I think of them as a neurologic drug. There are small studies that have suggested this, but I think, again, we’re going to need more data and larger-scale trials to demonstrate that.
Whether those are going to happen or not, there may be concerns about making those tests because people don’t necessarily want to get into certain areas with those drugs. I think those studies do need to be done, not just for strokes and dementia, but for other neurological and potentially even mental health disorders.
Harrington: The list keeps growing. Every month or so when you go to a meeting and you look at effects of the GLP-1s, and it’s like, whoa, where’d that one show up from?
You were brought to the AHA after a really successful career at Columbia as an academic stroke neurologist. You’ve been a longtime AHA volunteer. You’ve wanted to passionately get the AHA engaged in brain health. Give us a sense, when we say the AHA’s getting involved in brain health, what that actually means without giving us any secret information.
Elkind: As we’ve been talking about, there’s the connection between the heart and the brain, but I think we’ve always really focused on that heart piece of it. What’s good for the heart’s good for the brain. Any benefits that the brain may accrue from taking care of the heart are sort of like gravy. That’s a nice thing to have.
Harrington: Gravy’s probably not a good thing to have for your heart, particularly here in New Orleans.
Elkind: That’s true. There are really interesting ways, of course, in which the brain also has benefits for the heart. As you say, we’re sitting here in New Orleans where there’s an interest in voodoo, and for many years of course we’ve known about the syndrome of voodoo death. What is the cause of voodoo death? You’re literally scaring someone to death.
The presumed mechanism is you’re affecting the brain, which leads to an extreme sympathetic output that puts strain on the heart, and that can lead to something like takotsubo cardiomyopathy, where the heart doesn’t pump normally without ischemic disease, or at its worst extreme, sudden cardiac death. There’s a great example of how the brain can influence the heart as well.
There are others, too. I mean, you talk about the various risk factors. There are, let’s say, brain-related risk factors for heart disease, too. I’m thinking about things like depression, anxiety, loneliness, social isolation, and these kinds of factors.
Harrington: Those are risk factors for myocardial infarction.
Elkind: Exactly. Currently, they’re not actually in Life’s Essential 8, which is our easy-to-remember tool for people to cut down on their risk factors. The reason for that is simply there hasn’t been enough evidence on those benefits, but I could imagine in the near future we’ll be including those kinds of risk factors in our tools for assessing risk and helping people reduce their risk. Those are the kinds of things that I envision us doing.
There’s a growth in this area of brain health right now. Every neurological society started a brain health initiative within the last couple of years, which is super exciting. There are things that we can do for brain health that we never had available in the past. There’s a large amount of excitement around brain health. I think what the AHA can offer is that connection to the heart and, frankly, the rest of the body.
The AHA has gotten more and more interested in the cardiovascular kidney metabolic syndrome. That basically includes everything in the body except for the brain. I think we’ll be putting the brain back into that equation as well, and thinking holistically about health.
Harrington: One of the things that the AHA is so good at is thinking about: What are new therapies? What are new approaches? How do you take clinical trial evidence and get it implemented into practice? We clearly need more clinical trials, but what kind of clinical trials?
What are the things that you would study, either from a strategy perspective or a medical intervention perspective, that might improve brain health, where we don’t have enough data, but we have a hypothesis?
Elkind: There are a couple of areas that I would highlight where we’re beginning to take steps. One is this question of how a stroke might ultimately lead to cognitive decline in dementia. If you think about the traditional idea of stroke, the thought is that you go through life at a certain level of function, you have a stroke, you lose certain functions, become paralyzed, or lose the ability to speak. And almost everybody, if they don’t die from a fatal stroke, they recover from the stroke to some new baseline level of function.
Then we think: Okay, and then you go through life at that level until you have another stroke. In fact, what we see in observational human studies as well as animal studies is that people actually decline at a certain point after a stroke. Maybe not everybody, but a good chunk of patients decline, and we all decline obviously over time, but we see an accelerated decline in people who’ve had a stroke.
The hypothesis is that having had a stroke, that damage to the brain actually sets up a chronic condition whereby there’s accelerated neurodegeneration, breakdown of the blood-brain barrier, and perhaps neuroinflammation.
Several of us are interested in this idea that using an immune therapy or an anti-inflammatory therapy might help to mitigate that secondary, delayed cognitive impairment and neurodegeneration. That’s like a connection between a stroke, which is certainly a vascular condition, and neurodegeneration, if you will.
Harrington: That gets at this whole concept that the AHA also talks about, which is health-adjusted life expectancy. It’s not just how long you live, but to your point, what’s the quality of how you live? How do you quantify that to really understand over the lifespan what actually the benefit of an intervention is?
Elkind: For sure. There’s a second area that I think is even more up your alley perhaps. If you think about patients with heart failure, we know from some studies that assessing for mental health disorders like depression or anxiety, and then treating them if present, can help to improve outcomes in patients with heart failure.
When we think about brain health, we’re talking not only about neurological disorders where there’s structural injury to the brain, but also mental health and behavioral health disorders, which are also, as we said, closely tied to heart disease.
One could imagine a study where you look at patients with heart failure, perhaps in our registries, like our Get With The Guidelines registries, which have been so effective at improving the quality of care and reducing disparities. One could also randomize patients and do a pragmatic trial within the registry, a registry-based trial, to test the benefit of assessment and treatment for mental health disorders. That would be another way to connect it all together, bringing the brain back to heart health.
Inflammation and Food
Harrington: I want to cover, in the last couple of minutes, two more topics. One of which is that I had an interview a couple of months ago that we posted with Eric Topol about his new book, Super Agers . His basic premise is that there are people who live into their nineties with no health problems, and then there’s a group of people who live into the nineties and they had many health problems along the way, but they still made it into their nineties.
He talks about the big three: cancer, heart disease, and neurodegeneration. One of the things he says is, as he talks about the different type of super agers, that there’s something about their immune system and inflammation that links them. You mentioned inflammation. What do we know about inflammation in the brain?
Elkind: Well, we know that inflammation and neuro-immunity play an important role in a number of conditions. The paradigmatic one is multiple sclerosis. That’s a neuro-immune condition. We see neuro-immune mechanisms playing an important role after stroke, as I mentioned. We can see how that leads to long-term decline.
Even in primary neurodegenerative diseases like Alzheimer’s disease, immunity is increasingly recognized to play an important role there. There are people doing studies using immunity to interfere with neurodegeneration. We still don’t really understand what the primary problem is in Alzheimer’s. There’s been a large amount of debate back and forth about whether it is amyloid or not.
Some people say that it must be amyloid because we see some benefits from these new anti-amyloid immunotherapies. But other people say, well, those effects are too modest. The truth is there’s probably several different types of Alzheimer’s disease, depending on what the underlying mutation is or causes are.
As I mentioned, many other things usually contribute to it also. Yes, there seems to be some evidence that immune mechanisms play a role, but we haven’t yet proven that treating those will lead to a benefit.
Harrington: The hypothesis might be there, but we don’t know about interfering with it, whether or not that helps.
Final topic. The other thing that you’ve been involved with the last few years with the Heart Association has been, “Food is healthcare, food is medicine.” Food is medicine for the brain? We talk about ultra-processed foods and the deleterious effect it has on us — from an obesity perspective and it certainly seems to have an effect on heart disease. What about the brain?
Elkind: One hundred percent. We are looking at many other conditions. We haven’t yet focused on the brain in our healthcare by food initiative, which is all about food as medicine. We do have a trial that’s looking at “food as medicine” approaches after stroke.
It makes sense, right? When somebody has a stroke, they may lose the ability to cook, to even shop for themselves, and they may have to resort to eating less healthy foods. Stroke, I think, is a great example of where there may be a benefit for food-as-medicine programs, like medically tailored meals, for example, that will take some of those issues about cooking off the table.
Harrington: It’s not so much that you have food for the brain, so to speak, but it’s the fact that you are taking into account the disability of stroke.
Elkind: That’s a piece of it. I think that accentuates the benefit, but I think there’s also the fact that medically tailored meals, to the extent they will help reduce blood pressure, could be of benefit for reducing recurrent stroke. Yes, there is evidence that, even for patients with cognitive decline and dementia, that healthy food can be of benefit. There’s something called the MIND diet. I think of it as the Mediterranean diet plus blueberries.
Harrington: Blueberries as an antioxidant.
Elkind: Exactly. It emphasizes that benefit of antioxidants on top of the Mediterranean diet benefits, and that has been shown to have benefits for cognition and dementia.
Harrington: You are going to have no shortage of things to work on over the next few years.
Elkind: I’m excited about that.
Harrington: That’s fantastic. I hope that you can come back as some of these activities and initiatives get launched and we can talk more about it. One of the things that people write into us about is to try to understand more about healthy living and healthy brain living, so we’d love to chat more about this.
Elkind: I look forward to it. Thanks a lot, Bob.
Harrington: I want to thank you for listening. My guest here today has been Mitch Elkind, who is the Chief Science Officer for Brain Health and Stroke at the American Heart Association. He’s also a professor emeritus of neurology at Columbia University. I want to thank you for listening here on Medscape Cardiology and theheart.org.
If you liked it, tell us what you liked about it. If you didn’t like the show, give us some suggestions. If there are people you’d like to see me talk about or talk with, please do leave a comment for us so that we can think about whether or not that will appeal to our broader audience.
Again, I’m Bob Harrington. Thanks for listening.
Robert A. Harrington, MD, is the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine and provost for medical affairs of Cornell University, as well as a former president of the American Heart Association. He cares deeply about the generation of evidence to guide clinical practice. When not focusing on medicine, Harrington dreams of being a radio commentator for the Boston Red Sox.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Stroke, Dementia, Voodoo Death: The Heart-Brain Connection - Medscape - Jan 26, 2026.
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