Impact of Anticholinergic Medication Load on Cardiovascular Events
Overview
This population-based cohort study from Stockholm, Sweden, examined the association between anticholinergic medication burden and incident cardiovascular events in adults aged 45 and older. Findings suggest that higher cumulative anticholinergic drug exposure is linked to an increased incidence of various cardiovascular diseases.
Background
Anticholinergic drugs, which inhibit acetylcholine activity, are commonly prescribed to older adults for diverse conditions and can cause adverse effects beyond their primary indications. The cumulative use of such drugs, termed anticholinergic burden, has been associated with negative health outcomes like cognitive impairment and fractures, but its relationship with cardiovascular disease (CVD) is less clear. Cholinergic signaling plays a critical role in cardiovascular regulation, and disruption by anticholinergic drugs may impair cardiac function and autonomic balance. Prior studies have shown associations between anticholinergic burden and stroke or general cardiovascular risk, but evidence remains limited and often lacks differentiation among CVD types.
Data Highlights
The study utilized data from the Stockholm CREAtinine Measurements (SCREAM) project, including all residents aged ≥45 years without prior major CVDs from 2008 to 2021. Anticholinergic burden was quantified using the Anticholinergic Cognitive Burden (ACB) scale and cumulative defined daily doses (DDDs) of anticholinergic drugs dispensed annually. Exposure categories were 0, 1–89, 90–364, and ≥365 DDDs. Outcomes included incident cardiovascular events leading to hospitalization, with time-updated exposure assessments over follow-up.
Key Findings
Higher annual cumulative anticholinergic drug use was associated with an increased risk of incident cardiovascular events.
Time-updated analyses accounting for changes in drug exposure over time strengthened the observed associations.
Both overall cardiovascular disease risk and specific CVD types, such as myocardial infarction and stroke, were linked to greater anticholinergic burden.
Use of the ACB scale score as a secondary exposure measure corroborated findings from cumulative DDD analyses.
The study controlled for confounders including demographics, comorbidities, and socioeconomic status using comprehensive linked administrative data.
Clinical Implications
Clinicians should be aware of the potential cardiovascular risks associated with cumulative anticholinergic medication use, especially in older adults. Regular medication reviews to minimize unnecessary anticholinergic burden may help reduce incident cardiovascular events. Consideration of alternative therapies with lower anticholinergic activity could improve cardiovascular outcomes.
Conclusion
This large population-based study provides evidence that greater anticholinergic medication load is linked to increased incidence of cardiovascular events. These findings highlight the importance of cautious prescribing and monitoring of anticholinergic drugs to mitigate cardiovascular risk.
References
Stockholm CREAtinine Measurements (SCREAM) project -- Data source
