How Atrial Fibrillation May Affect Your Brain

This heart rhythm disorder is linked to thinking and memory problems. But anti-clotting drugs may lower the risk.

How Atrial Fibrillation May Affect Your Brain
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How Atrial Fibrillation May Affect Your Brain

How Atrial Fibrillation May Affect Your Brain

Bouts of atrial fibrillation, or afib — a rapid, chaotic heartbeat — make some people feel lightheaded and dizzy, while others don't notice any symptoms. But the most serious threat of this condition is the higher risk of stroke among people with afib compared with those without the disorder (see "Blood clot dangers, large and small"). Now, there's a growing recognition that people with afib also face an increased risk of thinking and memory problems — even if they do not experience a stroke.

Known as cognitive impairment, these problems include trouble remembering, learning new things, concentrating, or making routine decisions. The presumed underlying cause? Tiny blood clots that cause "silent" (that is, unrecognized) strokes and gradually injure parts of the brain involved with cognition.

"Until recently, very little was known about the association between afib and cognitive impairment," says Dr. Moussa Mansour, director of the atrial fibrillation program at Harvard-affiliated Massachusetts General Hospital. But an expert consensus statement on arrhythmias and cognitive function, published March 23 in the Journal of Arrhythmia, outlines the evidence for the connection and offers advice for preventing the problem.

Silent strokes usually don't cause noticeable symptoms because they are very small and often occur in the front of the brain rather than in areas that affect movement and speech, Dr. Mansour explains. "But in people with afib, these tiny strokes tend to recur over the years, and the damage is cumulative." Brain imaging studies suggest that afib doubles the risk of silent strokes. These, in turn, are linked to a higher risk of cognitive decline.

Drugs that help prevent blood clots (also called anticoagulants or blood thinners) are a vital part of afib treatment. All anticoagulants increase the risk of potentially dangerous bleeding in the gastrointestinal tract or brain, which is why they aren't appropriate unless a person's stroke risk outweighs the risk of bleeding. To decide, doctors use a tool that considers other stroke risk factors, such as age, sex, and cardiovascular problems (see "A scoring system for people with afib").

For decades, warfarin (Coumadin) was the drug of choice for stroke prevention. But it requires frequent monitoring and possible dose adjustments, and it interacts with many foods and other drugs. Now, doctors are more likely to prescribe novel oral anticoagulants (NOACs), which don't have the same downsides. Compared with warfarin, NOACs are at least as effective for preventing strokes and are less likely to cause dangerous bleeding in the brain, says Dr. Mansour. However, an estimated 40% of people with atrial fibrillation who should be taking an anticoagulant drug are not, he says. According to the consensus statement, people with afib who qualify for anticoagulation therapy should consider taking a NOAC, which may also help prevent cognitive impairment by preventing strokes.

People with afib should also focus on other healthy habits to lower their risk. These include exercising, losing weight if you're overweight, and treating sleep apnea, high blood pressure, and high cholesterol. Many studies show an association between alcohol consumption and afib, so Dr. Mansour suggests limiting alcohol to occasional use if you have afib.

(Harvard Health Letter)
)(Tribune Media)



Iran Envoy: Jareesh is Part of Our Culture, I Prefer It to Mandi

Enayati says regional ties run deep through shared history (Photo: Turki Al-Oqaili)
Enayati says regional ties run deep through shared history (Photo: Turki Al-Oqaili)
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Iran Envoy: Jareesh is Part of Our Culture, I Prefer It to Mandi

Enayati says regional ties run deep through shared history (Photo: Turki Al-Oqaili)
Enayati says regional ties run deep through shared history (Photo: Turki Al-Oqaili)

With a warm smile and a calm tone, Dr. Alireza Enayati, Iran’s ambassador to Saudi Arabia, reflects on nearly two years in Riyadh, describing a personal journey shaped by culture, cuisine, and diplomacy.

“I’ve visited different regions and tasted traditional Saudi dishes,” Enayati told Asharq Al-Awsat in an interview. “Jareesh –a dish made from cracked wheat and cooked with meat, spices, and vegetables– has become my favorite—I choose it over mandi and other dishes on any occasion.”

According to the Iranian envoy, the two countries share more than just geography. “There are many common dishes between Saudi Arabia and Iran,” he said.

But food is only one layer of the ambassador’s experience. Enayati, who has spent over two decades immersed in Middle East diplomacy, sees deep historical ties binding the region’s peoples together.

“I recently read Al-Hadaqi, a novel about Al-Jahiz—Abu Uthman Amr ibn Bahr—and his life between Baghdad, Basra, and Iran. It left me with a strong sense that the relationships among peoples in this region go far back in history,” he said. “Reading it felt like tracing our steps backward to better understand the present.”

“These are not new connections,” he added. “We’re not creating the relationship—we’re nurturing what has always existed. The cultural and civilizational dialogue has never ceased.”

His comments come against the backdrop of a thaw in relations between Tehran and Riyadh, after both sides agreed in March 2023—under Chinese mediation—to restore diplomatic ties following a seven-year rift.

The ambassador pointed to culinary overlaps as another reflection of cultural convergence. “Stews, for example, are common in both countries,” he said. “Jareesh is part of Iranian culture too, as are lamb and camel meat. And as everyone knows, kebab originated in Iran, but it’s also very popular here in the Kingdom.”

Enayati has built his career around the region. “I’ve spent more than 20 years working on regional affairs and never served outside this part of the world,” he said with a smile. “I’m not sure if that’s a strength or a limitation, but my focus has always been here.”

Appointed to Riyadh as part of a diplomatic breakthrough, Enayati said he is proud to represent Iran in Saudi Arabia. “It’s a great honor. I dedicate my efforts to enhancing bilateral ties and supporting regional peace and stability.”

Looking ahead, Enayati hopes to help build stronger cultural bridges—not only between Saudi Arabia and Iran, but across the broader region. “Arabic and Persian cultures both occupy a distinguished place,” he said. “We must deepen mutual understanding between them.”

He concluded with a nod to Tehran’s long-term vision for cooperation with Riyadh. “Iran and Saudi Arabia are both pillars of regional stability,” he said. “This region belongs to its people, and we view our relationship with the Kingdom through that lens.”