Title : Cardiovascular biomarkers as predictors of early cognitive decline in heart failure patients: A literature review
Abstract:
Background: Cognitive decline is a frequently under-recognised yet debilitating complication in patients with Heart Failure (HF), impacting quality of life, self-management, and long-term prognosis. Recent studies reveal a mechanistic overlap between cardiovascular dysfunction and neurodegeneration, particularly through the lens of the brain–heart axis. Vascular cognitive impairment in HF is increasingly attributed to cerebral hypoperfusion, neuroinflammation, and microvascular injury. Identifying specific cardiovascular biomarkers that predict early cognitive impairment offers potential for timely intervention, personalised risk stratification, and integrated cardiocognitive care pathways.
Methods: A structured literature review was conducted using PubMed, Embase, and Web of Science to identify peer-reviewed articles published between 2013 and 2025. Studies were included if they evaluated adult HF populations and examined associations between cardiovascular biomarkers such as NT-proBNP, high-sensitivity troponins, galectin-3, ST2, and CRP and cognitive performance assessed through validated neuropsychological tools. Both cross-sectional and longitudinal data were analysed and synthesised thematically.
Results: Recent evidence demonstrates that elevated NT-proBNP and high-sensitivity troponins are strongly associated with deficits in memory, attention, and executive function. Inflammatory markers including galectin-3 and CRP have been linked with hippocampal atrophy, systemic neuroinflammation, and progressive cognitive decline. Vascular biomarkers correlate with cerebral hypoperfusion and white matter changes on neuroimaging. These findings support the hypothesis that cardiovascular biomarkers reflect not only cardiac strain but also early cerebrovascular dysfunction.
Conclusion: Cardiovascular biomarkers show strong potential as non-invasive predictors of early cognitive decline in HF patients. Their clinical integration could enable earlier detection of neurocognitive risk, allowing for proactive monitoring, neuro-cardiology referral, and personalised management. These findings highlight the need for a biomarker-informed, multidisciplinary approach to managing the brain–heart axis in heart failure care.
