Early 20th century physician and psychotherapist Alfred Adler famously said, “Follow your heart but take your brain with you.” It’s prudent advice that also sums up the approach of C. Noel Bairey Merz, MD, director of the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai, in her investigation of potential links between coronary microvascular disease (CMD) and cerebral small-vessel disease (CSVD).

Over more than two decades, Bairey Merz has reshaped the landscape of cardiac medicine with the groundbreaking Women’s Ischemia Syndrome Evaluation (WISE), a multiyear, multicenter research project sponsored by the National Heart, Lung and Blood Institute. Now, with supplemental funding from the National Institute on Aging, she and her colleagues in the Cedars-Sinai Department of Neurology are expanding their focus to explore the relationship between CMD and CSVD, which can lead to cognitive decline.

“We tend to specialize in medicine, sometimes unintentionally putting on blinders and failing to see big-picture connections,” said Bairey Merz, who holds the Irwin and Sheila Allen Chair in Women’s Heart Research. “But there are clear similarities between the heart and the brain, and the vascular system goes everywhere. Both organs are affected by systemic inflammation and restricted blood flow due to atherosclerosis. It makes sense to ask whether microvascular disease burden is related across these major organ systems.”

The study will follow 100 participants enrolled in WISE, tracking their health with retinal imaging, peripheral vascular measurements and cognitive testing to see if the investigators can help detect early-onset Alzheimer’s disease in the participants.

Recent reports indicate that traditional cardiovascular management—including exercise, nutrition and better blood pressure control—can slow dementia progression. Use of cardiovascular drugs has also proven highly effective in protecting both small and large vessels in the heart.

“If we’re able to show overlap between vessels in the heart that we’ve characterized well and those in the brain, we may be able to leverage those tools in new and impactful ways,” Bairey Merz said.

The research also has potential implications for early disease detection.

“If you have dysfunction of the small heart vessels, it could make sense to be screened for similar dysfunction in the brain,” she said. “We know in many cases that early intervention is key to disease management, and being able to anticipate vascular change in the heart or brain could save lives.”