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What do we Spaniards die of, a society that just before the Covid-19 pandemic broke world records for life expectancy? Although the emphasis on the prevention of serious diseases such as that produced by the SARS-CoV-2 coronavirus or cancer is fully justified, the leading cause of mortality is still cardiovascular disease. Longevity also raises the problem of quality of life in the elderly, affected by prevalent disorders such as Alzheimer’s.

It is also about evils that collaborate with each other: the relationship between arterial and neurodegenerative problems in the elderly is known to researchers. But could this interaction be happening earlier, in the decades before Alzheimer’s breeds, and could the more subtle signs of cardiovascular disease help us stop both in time? This is what Marta Cortés Canteli and her team from the National Center for Cardiovascular Research (CNIC) are investigating, a project that has just received the impetus of one of the prestigious Leonardo Scholarships awarded by the BBVA Foundation.

What does it consist of studying the connection between cardiovascular disease and Alzheimer’s?

We work within the framework of PESA study, directed by Dr. Valentín Fuster of the CNIC and who mainly studies subclinical atherosclerosis. It is a disease that does not have any symptoms, and is studied in a population of more than 4,000 healthy participants. For years, we have been investigating the relationship between cardiovascular and neurodegenerative disease. Why? Because it is known that in symptomatic stages they occur jointly. People who have cardiovascular risk factors – blood pressure, diabetes, high cholesterol, obesity – also have a higher risk of suffering from Alzheimer’s and other forms of dementia in old age.

How could one detect if the undiagnosed arterial problem is also anticipating a future neurodegenerative deterioration?

It is not known what is the relationship between both diseases in the asymptomatic phase. Both have a very long subclinical stage, from 15 to 20 years. People who develop Alzheimer’s in their 70s already suffer after 50 brain changes that do not show symptoms, but are there. The project that we are going to carry out thanks to the Leonardo Grant will consist of analyzing in the population in that age range whether the plasma of patients with non-symptomatic cardiovascular disease indicates the elevation of a typical marker of Alzheimer’s disease. In this case, we will look at phospho-tau 181, which is very specific.

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What would the detection of this marker indicate to the investigator?

These biomarkers have been on the rise in the last year, because until now we were using markers in cerebrospinal fluid. It is still done in the clinic, but many plasma markers are beginning to be validated in experimentation. They are much easier to measure, and that is what we proposed for the Leonardo Grant: to use them to measure whether patients with subclinical atherosclerosis were beginning to suffer from preclinical Alzheimer’s.

Cardiovascular disease is prevalent in Spain and in the rest of the industrialized world. Can it be said that suffering from it predisposes to Alzheimer’s?

In advanced ages, yes; What we are investigating precisely is whether after 50 it can already be determined that the two diseases are appearing together, or if they are influencing each other. What is known is that keeping all cardiovascular risk factors at bay can be a drug therapy to delay the onset of Alzheimer’s. The cognitive training, or exercising the brain and keeping it active, is very important, which indicates that it has a very important vascular component. But it is not known when it begins.

Approaches to treating cardiovascular disease have to do with healthy and dietary habits. Do they also influence the delay in the onset of Alzheimer’s?

Everything that involves controlling cardiovascular risk – maintaining healthy lifestyle habits in terms of diet and exercise – is very healthy to avoid the onset of Alzheimer’s. It will not prevent it, but it allows you to gain quality of life.

An anti-inflammatory diet has also been linked to the prevention of Alzheimer’s.

Yes, it is known that there is a very important and double-edged inflammatory component. In fact, Alzheimer’s disease begins as an inflammation in the body, but beneficial, to try to eliminate these compounds that we know as senile plaques. However, at one point it runs out of control and can no longer fight the deposits, going on to contribute to the pathogenesis.

Can Dietary and Behavioral Approaches Relieve Alzheimer’s Symptoms Like They Do With Cardiovascular Disease?

That is the idea behind the project: if controlling a disease that is modifiable such as cardiovascular disease can have an impact on neurodegenerative disease in the long term. If we indeed see that people with a heart problem, even if it is subclinical, are also developing Alzheimer’s in the preclinical phase, we can see how the control of risk factors influences: not smoking, eating well, controlling hypertension … we all know that , but if they also tell you: “Hey, this can have an impact on how your brain will be in a few years” … Well, maybe people are starting to think about it!

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Are these habits especially important in people who have a history of Alzheimer’s in your family?

There are people who suffer from Alzheimer’s at a very young age, and who have a strong genetic component. It is only 5% of patients, and in this case, it will be more difficult to control. But for the rest, 95% of Alzheimer’s cases, it may be important to take care of cardiovascular risk factors even if there are genes involved. Even in people predisposed by their genotype, the risk can be normalized.

What objectives did the team have when applying for the Leonardo Grant?

The search for funding is something that is behind all scientific teams. And not only the scholarship, but enter the Leonardo Network It opens many doors for you and gives you a lot of visibility. That the foundations are providing facilities for science to move forward is essential for biomedical projects. And it is an honor to be part of it, we are eternally grateful.

Another CNIC researcher, Pilar Martín, has successfully completed her myocarditis prevention project promoted by a Leonardo Grant. Is it an inspiration?

We scientists are based precisely on that: everything we do is for the good of the patient, as Pilar has done, with a publication in one of the most important magazines. And without funding from the scholarship, this could not have happened.

What would be the main request of basic science researchers?

I am in a prestigious center, and I can “complain” little. But it is true that the temporary nature of researchers’ contracts is a very important problem, along with bureaucracy and lack of funding. These are three structural problems that Spain has had for a long time, but we could be talking for hours! The pandemic has shown how important it is to invest in science, and it is also essential that society is involved and that it understands what we scientists do.

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