Abstract
Background. Dementia and cardiovascular disease (CVD) are frequently comorbid. The presence of dementia may have an effect on how CVD is treated. Objective. To examine the effect of dementia on the use of four medications recommended for secondary prevention of ischemic heart disease (IHD): angiotensin-converting enzyme inhibitors, beta-blockers, lipid-lowering medications, and antiplatelet medications. Design. Retrospective analysis of data from the Cardiovascular Health Study: Cognition Study. Setting and Subjects. 1,087 older adults in four US states who had or developed IHD between 1989 and 1998. Methods. Generalized estimating equations to explore the association between dementia and the use of guideline-recommended medications for the secondary prevention of IHD. Results. The length of follow-up for the cohort was 8.7 years and 265 (24%) had or developed dementia during the study. Use of medications for the secondary prevention of IHD for patients with and without dementia increased during the study period. In models, subjects with dementia were not less likely to use any one particular class of medication but were less likely to use two or more classes of medications as a group (OR, 0.60; 95% CI, 0.36–0.99). Conclusions. Subjects with dementia used fewer guideline-recommended medications for the secondary prevention of IHD than those without dementia.
Highlights
Among medicare beneficiaries diagnosed with dementia, 30% have a diagnosis of ischemic heart disease (IHD) [1], and as many as 54% have had a myocardial infarction at some point in their lives [2], making them candidates for the use of medications for the secondary prevention of IHD
Dementia in older adults has an effect on the management of comorbid cardiovascular disease: patients with myocardial infarction are half as likely to receive invasive cardiac procedures if they have dementia listed in their hospital chart [9]; community-dwelling patients with a diagnosis of dementia are less likely to use either cardiovascular medications [10] or a lipid-lowering medication [11], and even after controlling for IHD, use of cardiovascular medications Journal of Aging Research is lower in nursing home residents with dementia, especially severe dementia [12]
Our study sample consisted of the 1,087 Cardiovascular Health StudyCognition Study (CHS-CS) participants who had IHD; 591 subjects had IHD at baseline, and 496 developed IHD during the study period
Summary
Among medicare beneficiaries diagnosed with dementia, 30% have a diagnosis of ischemic heart disease (IHD) [1], and as many as 54% have had a myocardial infarction at some point in their lives [2], making them candidates for the use of medications for the secondary prevention of IHD. While the presence of clinical dementia plays a role in decisions to use invasive procedures and medications for the management of CVD, no studies, to date, have examined and compared the use of medications recommended for the secondary prevention of IHD in a population with and without dementia over time. We used an epidemiologic cohort of subjects serially assessed for dementia and IHD to explore the relationship between dementia and the use of guideline-recommended medications for the secondary prevention of IHD between 1989-1998, a decade with substantial growth in the use of these medications. To examine the effect of dementia on the use of four medications recommended for secondary prevention of ischemic heart disease (IHD): angiotensin-converting enzyme inhibitors, beta-blockers, lipid-lowering medications, and antiplatelet medications. Subjects with dementia used fewer guideline-recommended medications for the secondary prevention of IHD than those without dementia
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
