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Calcium channel blockers, survival and ischaemic stroke in patients with dementia: a Swedish registry study
I Kalar1,2,3, H Xu4, J Secnik4
1From the, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Insights
Calcium channel blockers (CCBs) effects on dementia patients are unclear. Amlodipine use in Alzheimer's dementia (AD) and dementia with Lewy bodies/Parkinson's disease dementia (DLB-PDD) patients was linked to lower mortality and stroke risks.
Area of Science:
- Gerontology
- Pharmacology
- Neurology
Background:
- The impact of calcium channel blockers (CCBs) on mortality and ischemic stroke risk in dementia patients remains understudied.
- Hypertension is common in dementia patients, and CCBs are frequently prescribed.
Purpose of the Study:
- To assess the risk of death and ischemic stroke in dementia patients treated with CCBs.
- To analyze risks associated with individual CCB agents and dose-response relationships.
Main Methods:
- A longitudinal cohort study of 18,906 hypertensive dementia patients from the Swedish Dementia Registry (2008-2014).
- Inclusion of data on comorbidities, dispensed medications, and outcomes from national registries.
- Consideration of individual CCB agents and cumulative defined daily doses (cDDD).
Main Results:
- Nifedipine use was associated with an increased mortality risk (aHR 1.32) compared to non-CCB users.
- Amlodipine use in Alzheimer's dementia (AD) and dementia with Lewy bodies/Parkinson's disease dementia (DLB-PDD) patients showed reduced mortality risk (aHR 0.89 and 0.58, respectively).
- Amlodipine use in AD patients was linked to a lower ischemic stroke risk (aHR 0.63) compared to other CCBs.
Conclusions:
- Amlodipine use is associated with reduced mortality in dementia patients with AD and DLB-PDD.
- AD patients using amlodipine demonstrated a lower risk of ischemic stroke compared to users of other CCBs.
Background:
The effect of calcium channel blockers (CCB) on mortality and ischaemic stroke risk in dementia patients is understudied.
Objectives:
To calculate the risk of death and ischaemic stroke in dementia patients treated with CCBs, considering individual agents and dose response.
Methods:
Longitudinal cohort study with 18 906 hypertensive dementia patients from the Swedish Dementia Registry (SveDem), 2008-2014. Other Swedish national registries contributed information on comorbidities, dispensed medication and outcomes. Individual CCB agents and cumulative defined daily doses (cDDD) were considered.
Results:
In patients with hypertension and dementia, nifedipine was associated with increased mortality risk (aHR 1.32; CI 1.01-1.73; P < 0.05) compared to non-CCB users. Patients diagnosed with Alzheimer's dementia (AD) or dementia with Lewy bodies/Parkinson's disease dementia (DLB-PDD) taking amlodipine had lower mortality risk (aHR, 0.89; CI, 0.80-0.98; P < 0.05 and aHR 0.58; CI, 0.38-0.86; P < 0.01, respectively), than those taking other CCBs. Amlodipine was associated with lower stroke risk in patients with Alzheimer's dementia compared to other CCBs (aHR 0.63; CI, 0.44-0.89; P < 0.05). Sensitivity analyses with propensity score-matched cohorts repeated the results for nifedipine (aHR 1.35; 95% CI, 1.02-1.78; P < 0.05) and amlodipine in AD (aHR, 0.87; CI, 0.78-0.97; P < 0.05) and DLB-PDD (aHR, 0.56, 95%CI, 0.37-0.85; P < 0.05).
Conclusion:
Amlodipine was associated with reduced mortality risk in dementia patients diagnosed with AD and DLB-PDD. AD patients using amlodipine had a lower risk of ischaemic stroke compared to other CCB users.
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