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Cardiovascular Outcomes Associated with Cholinesterase Inhibitor Use in Individuals at High Cardiovascular Risk
Jiann-Der Lee1,2, Chuan-Pin Lee3, Yen-Chu Huang1,2
1Department of Neurology, Chiayi Chang Gung Memorial Hospital, No. 2, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 613016, Taiwan, ROC.
Insights
Cholinesterase inhibitors (ChEIs) may reduce major adverse cardiovascular events (MACE) and improve survival in high-risk individuals. This study found ChEI use associated with lower MACE risk and better overall survival.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Cholinesterase inhibitors (ChEIs) are common dementia treatments.
- Their cardiovascular effects in high-risk populations are not well understood.
Purpose of the Study:
- To assess the association between ChEI use and major adverse cardiovascular events (MACE) in high-risk individuals.
- To evaluate the impact of ChEIs on all-cause mortality in this population.
Main Methods:
- Retrospective cohort study (2001-2022) using the Chang Gung Research Database.
- 1:1 matching of 21,598 ChEI users and non-users (age ≥50) with cardiovascular risk factors.
- Primary outcome: time to first MACE (stroke, myocardial infarction, cardiovascular death); secondary outcomes: survival.
Main Results:
- ChEI use was linked to a significantly lower risk of MACE (aHR 0.79; P < 0.001).
- Specifically, ChEI users had reduced risk of acute myocardial infarction (aHR 0.70; P = 0.006).
- ChEI users demonstrated significantly improved overall survival (log-rank P < 0.001).
Conclusions:
- Cholinesterase inhibitor use is associated with reduced cardiovascular event risk and enhanced survival in high-risk patients.
- Findings suggest potential cardiovascular benefits of ChEIs beyond cognitive enhancement.
Background:
Cholinesterase inhibitors (ChEIs) are widely prescribed for dementia, but their effects on cardiovascular outcomes in high-risk populations remain unclear.
Objectives:
Our objective was to evaluate the association between ChEI use and the risk of major adverse cardiovascular events (MACE) and all-cause mortality among individuals with high cardiovascular risk.
Methods:
We conducted a retrospective cohort study using data from the Chang Gung Research Database in Taiwan from 2001 to 2022. Individuals aged ≥ 50 years with cardiovascular risk factors who received ChEIs were matched 1:1 with non-users based on birth year, sex, history of dementia, and cardiovascular comorbidities. The primary outcome was time to first MACE, defined as hospitalization for acute ischemic stroke, acute myocardial infarction, or cardiovascular death. Secondary outcomes included individual cardiovascular events, heart failure, and all-cause mortality. Competing risk and survival analyses were performed using Fine and Gray subdistribution hazard models and Cox proportional hazards models, respectively.
Results:
Among 21,598 matched patients (mean age 77.7 years; 61.1% female), ChEI use was associated with a significantly reduced risk of MACE (adjusted subdistribution hazard ratio 0.79; 95% confidence interval 0.74-0.84; P < 0.001) and acute myocardial infarction (adjusted subdistribution hazard ratio 0.70; 95% confidence interval 0.55-0.90; P = 0.006). ChEI users also had significantly improved overall survival (log-rank P < 0.001).
Conclusions:
ChEI use is associated with a lower risk of major cardiovascular events and improved survival in patients at high cardiovascular risk. These findings suggest potential cardiovascular benefits of ChEIs beyond cognitive symptom management.
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