In
many Asian languages, the same ancient letter/symbol is used for heart and mind. For the
last couple of millennia, physicians and scientists across different
civilizations have posited
close links between the brain and heart, even arguing that the site of
intelligence and
emotions is in one of these two organs. Through an integrative empirical
approach in modern
biology/physiology and behavioral sciences, much has since been learned to confirm
the anatomical and functional links between the brain and the heart. Arguably, the
ultimate applicability of this knowledge will advance our health and improve
disease treatment.
Modern
medicine is characterized by a high degree of specialization, and the heart-brain
connection is typically considered from the point of view of a particular medical
specialty. Hence, focusing on the brain, for example, in neurology,
cardiovascular involvement is critical in certain pathologies such as stroke
and vascular dementia. In cardiology, on the other hand, the influence of the
brain becomes clearly apparent in “the broken heart syndrome” (also
known as acute stress cardiomyopathy). However, recent epidemiological studies
point to new associations that typically present as co-occurring pathologies of
both the brain and the heart. A case in point is the association between depression
and coronary heart disease. Such co-occurrences have stimulated research into possible
novel mechanisms that could be targeted to treat these complex cardiovascular/brain
disorders.
At
least three scenarios could be at play in these illnesses: (i) the primary pathological
mechanism in the nervous system triggers a cardiovascular pathology by disrupting
physiological links between the two systems (hence, the term
“psychogenic”cardiovascular disease), (ii) the primary pathological
mechanism in the cardiovascular system
triggers a nervous system dysfunction (e.g., atherosclerosis leading to
ischemic conditions
causes subsequent cognitive impairment), and (iii) the primary pathology is in
a biological mechanism that is normally operative in both the nervous and the cardiovascular
systems, thus causing the co-occurrence of pathologies (i.e., the co-occurring pathologies
share a pathobiological mechanism but do not necessarily cause each
other).
To be
successful, research in co-occurring cardiovascular and brain disorders needs
contributions from multiple medical specialties, including psychiatry,
neurology, medicine,
and cardiology. It should encompass clinical and basic research as well as the development
of therapeutic approaches. The purpose of Cardiovascular Psychiatry and Neurology
is to provide a platform for the latest research and for timely and expert reviews
and comments in the emerging field of cardiovascular psychiatry and neurology. Although
the term cardiovascular psychiatry and neurology is introduced here for the
first time, retrieving publications from PubMed using either cardiovascular psychiatry or cardiovascular neurology generates relevant information
(oftentimes because
the terms psychiatry or neurology appear in the tile of a journal
publishing the work). A quick survey of PubMed for the publication period from 1940 to 2008 (Table 1) revealed,
not surprisingly, that the number of items per search term has increased dramatically
over the years. Whereas the term cardiovascular showed a sharp increase in the
early sixties, both neurology and psychiatry “exploded”
in the early nineties. Even though
the term cardiovascular psychiatry appeared earlier than cardiovascular neurology,
the later term has become more prevalent since the early sixties (Table 1). Normalizing
the data, that is, by expressing cardiovascular psychiatry as a
percentage of corresponding psychiatry and cardiovascular neurology as a percentage of the corresponding neurology (Figure 1), showed that cardiovascular neurology rose
sharply in
the early sixties and has remained at about 5% of all neurology-related
items. On the other
hand, cardiovascular psychiatry had been below 1% of all psychiatry-related
items until
the early eighties, but has gradually increased. Possibly, the ischemia-related
brain disorders
have contributed to the relatively high presence of cardiovascular neurology and
the relatively recent revelation of an unsuspected association of cardiovascular disorders with mood disorders might have contributed to the increase in cardiovascular
psychiatry. The
journal Cardiovascular Psychiatry and Neurology was created to provide
for the
first time a unified forum to consider the physiological and pathological
interactions between
the nervous and the cardiovascular systems. The journal aims to stimulate the development
of relevant interdisciplinary and collaborative biomedical research and to foster
multidisciplinary efforts in advancing medical practices.
A number of PubMed items retrieved on
January 13, 2009. The terms indicated in
the table were searched (http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed)
for the indicated
publication dates (years). No systematic checking was performed for the actual content of individual retrieved items.
Years
Cardiovascular
Neurology
Psychiatry
Cardiovascular neurology
Cardiovascular psychiatry
1940–1949
1712
78
905
0
3
1950–1959
23981
1897
5445
18
13
1960–1969
76270
3641
10080
181
55
1970–1979
151268
4244
14083
216
25
1980–1989
195001
13607
22791
638
188
1990–1999
277125
56631
63399
3152
863
2000–2008
343100
82538
87576
4468
1377
The proportions of retrieved PubMed
terms Cardiovascular Psychiatry versus Psychiatry
and Cardiovascular Neurology versus Neurology. The PubMed search was performed
as described in Table 1. The percentages of items found for Cardiovascular Psychiatry and Cardiovascular Neurology were calculated based on the
corresponding 100% values retrieved for Psychiatry and Neurology, respectively.