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The Brain–Heart Axis: Neuroinflammatory Interactions in Cardiovascular Disease

  • Nuclear Cardiology (V Dilsizian, Section Editor)
  • Published:
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Abstract

Purpose of Review

The role of neuroimmune modulation and inflammation in cardiovascular disease has been historically underappreciated. Physiological connections between the heart and brain, termed the heart-brain axis (HBA), are bidirectional, occur through a complex network of autonomic nerves/hormones and cytokines, and play important roles in common disorders.

Recent Findings

At the molecular level, advances in the past two decades reveal complex crosstalk mediated by the sympathetic and parasympathetic nervous systems, the renin-angiotensin aldosterone and hypothalamus-pituitary axes, microRNA, and cytokines. Afferent pathways amplify proinflammatory signals via the hypothalamus and brainstem to the periphery, promoting neurogenic inflammation. At the organ level, while stress-mediated cardiomyopathy is the prototypical disorder of the HBA, cardiac dysfunction can result from a myriad of neurologic insults including stroke and spinal injury. Atrial fibrillation is not necessarily a causative factor for cardioembolic stroke, but a manifestation of an abnormal atrial substrate, which can lead to the development of stroke independent of AF.

Summary

Central and peripheral neurogenic proinflammatory factors have major roles in the HBA, manifesting as complex bi-directional relationships in common conditions such as stroke, arrhythmia, and cardiomyopathy.

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Funding

Michael G. Nanna reports research funding from the Patient-Centered Outcomes Research Institute and the American College of Cardiology and grants from Yale Claude D. Pepper Older Americans Independence Center (P30AG021342) and the National Institute on Aging (R03AG074067); none of this funding is related to this manuscript.

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  1. Jiun-Ruey Hu and Ahmed Abdullah contributed equally to the project.

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  1. Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA

    Jiun-Ruey Hu, Ahmed Abdullah, Michael G. Nanna & Robert Soufer

  2. VA Connecticut Healthcare System, 950 Campbell Ave, -111B, West Haven, CT, 06516, USA

    Robert Soufer

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Hu, JR., Abdullah, A., Nanna, M.G. et al. The Brain–Heart Axis: Neuroinflammatory Interactions in Cardiovascular Disease. Curr Cardiol Rep 25, 1745–1758 (2023). https://doi.org/10.1007/s11886-023-01990-8

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