Acetylcholinesterase inhibitors and risk of stroke and death in people with dementia

The long article for discussion on the August 31, 2018 #GeriMedJC will take a look at Acetylcholinesterase inhibitors and risk of stroke and death in people with dementia.

Remember during the live hour, you can view the presentation live via Zoom  https://zoom.us/j/102282147 . Have you missed our previous sessions? The 2018 presentations are all available on YouTube (click the Subscribe button!): https://www.youtube.com/channel/UC0lfYRt-7pBKFG_81JHUyWg

Acetylcholinesterase inhibitors and risk of stroke and death in people with dementia. Alzheimers Dement. 2018 Jul;14(7):944-951.

INTRODUCTION:
The aim of this study was to investigate the association between acetylcholinesterase inhibitor (AChEI) use and risk of ischemic stroke and death in people with dementia.

METHODS:
A cohort study of 44,288 people with dementia registered in the Swedish Dementia Registry from 2007 to 2014. Propensity score-matched competing risk regression models were used to compute hazard ratios and 95% confidence intervals for the association between time-dependent AChEI use and risk of stroke and death.

RESULTS:
Compared with matched controls, AChEI users had a lower risk of stroke (hazard ratio: 0.85, 95% confidence interval: 0.75-0.95) and all-cause death (hazard ratio: 0.76, 95% confidence interval: 0.72-0.80). After considering competing risk of death, high doses (≥1.33 defined daily doses) of AChEI remained significantly associated with reduced stroke risk.

DISCUSSION:
The use of AChEIs in people with dementia may be associated with reduced risk of ischemic stroke and death. These results call for a closer examination of the cardiovascular effects of AChEIs.

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