What’s Good for the Heart May Not be Good for the Brain

We have been interviewing health experts for nearly 50 years on our nationally syndicated public radio show, The People’s Pharmacy. Over the decades we have spoken with many neuroscientists about preserving brain function as we age. A frequent phrase from these experts goes something like this: “What’s good for the heart is good for the brain.” The idea seemed simple and logical. Control blood pressure. Lower cholesterol. Exercise regularly. Eat healthy food. Such strategies should work in harmony and be good for the brain just as they were supposed to be good for the cardiovascular system.

Results

The new research was published in JAMA Neurology (March 23, 2026). It surprised everyone.

The authors asked a seemingly simple question:

“Can exercise, intensive pharmacological reduction of blood pressure (BP) and serum low-density lipoprotein cholesterol (LDL-C), or the combination of these interventions improve cognitive function in older adults with family history of dementia and/or self-reported subjective cognitive decline?”

A Well-Designed Study:

Researchers recruited 513 older adults between the ages of 60 and 85 who were at increased risk for dementia. To be included in this randomized clinical trial (RCT) they had to have a family history of dementia, “self-reported subjective cognitive decline,” difficulties on a test of cognitive function, and significant hypertension.

They also needed to have a “sedentary lifestyle.” In other words, they were not exercisers.

Volunteers were randomized to one of four groups.

• The “placebo” group got their standard care with nothing new or unusual added.

• Another group received intense aerobic exercise with supervision. These folks were encouraged to maintain 160 minutes of very intense exercise each week.

• If their LDL cholesterol levels were over 70 and they were in the group that received intensive pharmacological reduction of cardiovascular risk factor (IRVR) group, they received 80 mg of atorvastatin (Lipitor). They would also have been prescribed blood pressure lowering meds (losartan and/or amlodipine).

• A fourth group received both exercise supervision and medications to control blood pressure and LDL cholesterol.

To summarize: one group exercised regularly, another received intensive treatment to lower blood pressure and LDL cholesterol, a third group did both, and a fourth group received “usual” medical care.

Was This Heart Healthy Strategy Good for the Brain?

After two years, the researchers compared cognitive test scores among the groups. The result was unexpected and, frankly, disappointing:

“In this randomized clinical trial of 513 participants, moderate to vigorous aerobic exercise training, intensive pharmacological lowering of BP and serum LDL-C, or both did not result in statistically significant differences in improvements in global cognitive function over 24 months.”

In other words, the people who exercised and the people who took intensive cardiovascular medications did no better on memory and thinking tests than those who did not.

That finding seems to contradict decades of advice.

Is Lower Blood Pressure Good for the Brain?

The authors of the latest research mention the SPRINT MIND study:

“…in which intensive lowering of SBP [systolic blood pressure] did not result in statistically significant differences in cognitive function in adults aged 50 years or older. Our findings are also consistent with the HOPE-3 study, which showed no benefit of rosuvastatin on cognitive function with or without a combination with antihypertensive treatment in older adults aged 70 years or older.”

The SPRINT MIND trial was also disappointing (JAMA, Jan. 28, 2019):

“Among adults with hypertension, intensive blood pressure control did not significantly reduce the risk of probable dementia.”

Are Statins Good for the Brain?

Rita Redberg, MD, MSc, is a renowned cardiologist and past editor of JAMA Internal Medicine. Here is her assessment of “Statins for Primary Prevention” in JAMA Internal Medicine, Nov. 15, 2016):

“Using the current data, the decision aid shows that of 100 people who take a statin for 5 years, only 2 of 100 will avoid a myocardial infarction [heart attack], and 98 of the 100 will not experience any benefit. There will be no mortality benefit for any of the 100 people taking the medicine every day for 5 years. At the same time, 5 to 20 of the 100 will experience muscle aches, weakness, fatigue, cognitive dysfunction, and increased risk of diabetes.”

Perhaps you noted the term “cognitive dysfunction.”

Statins and Brain Function

A more recent study in the journal Neurotoxicology (March, 2026) suggests that statins might not be good for the brain. They offer an explanation for what the problem could be.

The authors introduce their statin research this way:

“Despite their [statins] widespread use, concerns persist regarding potential cognitive adverse effects, although a definitive causal relationship remains elusive.”

They go on to note:

“Post-marketing surveillance studies, case reports, and observational investigations have identified cognitive impairments − including confusion, forgetfulness, memory loss, mental impairment, and hallucinations − in patients receiving statin therapy. These symptoms may arise within days to several years after treatment initiation but are typically mild and reversible upon discontinuation.’

Statins and Microglia:

“We employed rosuvastatin as a representative statin to investigate the mechanisms underlying statin-associated cognitive dysfunction. Using network toxicology, we identified microglia as a key cell type in this pathology through cell type signatures enrichment analysis.

“In this study, we investigated the mechanisms underlying rosuvastatin-associated cognitive impairment through an integrative approach combining network toxicology, bulk RNA-sequencing dataset analysis, in vitro experimental validation, and computational simulations. Our network toxicology analysis suggested microglia as a pivotal cell type in the pathogenic processes linking rosuvastatin use to cognitive dysfunction.”

OK…that is highly technical and somewhat obscure. Microglia are specialized immune cells in the brain. Think of them a bit like scouts and garbage collectors. These cells are constantly looking for invaders (pathogens) and cellular abnormalities. They then help dispose of the bad guys and/or ineffective cellular debris. You want your microglia working well because these cells make up as much as 15% of all your brain cells and they play a critical function.

The atorvastatin dose employed in the JAMA Neurology (March 23, 2026) study was high (80 mg). We have no idea how that might or might not have affected microglia function. And we have no way of determining if that could have interfered with possible benefits of exercise. No one should ever stop any prescribed medication without discussing the pros and cons with a physician.

Don’t Give Up On the Idea That Exercise is Good for the Brain

Don’t give up on exercise just yet. The researchers noted that the study lasted only two years and was not designed to determine whether people developed dementia, only whether their cognitive test scores changed.

They concluded that longer studies are needed to determine whether exercise and aggressive treatment of cardiovascular risk factors can actually prevent dementia over the long term, even if short-term cognitive scores don’t change very much.

The People’s Pharmacy Perspective

We don’t think this new research means the old advice was wrong. But it does suggest the slogan “What’s good for the heart is good for the brain” may be too simplistic.

Exercise may help the brain not just by improving blood flow or lowering cholesterol, but by releasing chemical signals—what scientists now call exerkines—that reduce inflammation, repair the blood-brain barrier, and stimulate the growth of new brain cells.

That kind of protection may take many years to translate into preserved memory and reduced dementia risk.

So here’s the bottom line as we see it:

• Exercise may not make you sharper on a memory test next month.
• Lowering blood pressure into a safe range may not immediately improve recall.
• But both may still be quietly protecting your brain for the future.

In other words, what’s good for the heart may still be good for the brain—but the brain may take a lot longer to say thank you.

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