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Cholinesterase inhibitors 'reduce heart attack risk'

Patients taking cholinesterase inhibitors for Alzheimer’s disease have a reduced risks of myocardial infarction and death compared with cholinesterase inhibitor-naïve patients, show researchers.

The study

The Swedish researchers looked at 7,073 patients (mean age 79 years) with the diagnoses of Alzheimer’s dementia or Alzheimer’s mixed dementia. They looked at cholinesterase inhibitor use and linked it to diagnosed myocardial infarctions and death using national registers.

The results

During a mean follow-up period of 503 days, 831 (8%) subjects in the cohort suffered a myocardial infarction or died. Subjects who used cholinesterase inhibitors had a 34% lower risk for this composite endpoint during the follow-up period, compared with those who did not. Cholinesterase inhibitor use was also associated with a lower risk of death and myocardial infarction. Patients taking the highest recommended dose of cholinesterase inhibitor (donepezil 10mg, rivastigmine >6mg, galantamine 24mg) had the lowest risk of myocardial infarction or death compared with cholinesterase inhibitor-naïve patients.

What this means for GPs

The researchers note that ‘cholinesterase inhibitor use was associated with a ~35% reduced risk of myocardial infarction or death’ but advise that ‘it would be of value if the results could be confirmed in a study with higher evidence’ as the study was observational.

Eur Heart J 2013, online 5 June

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