Impact of acetylcholinesterase inhibitors on the occurrence of acute coronary syndrome in patients with dementia.

Ping-Hsun Wu,Chia-Tsuan Huang,Yi-Hsin Yang,Yi-Ting Lin,Tsung-Hsien Lin,Po-Chao Hsu

doi:10.1038/srep15451

Abstract

The study aimed to investigate the association of acetylcholinesterase inhibitors (AChEIs) use with the risk of acute coronary syndrome (ACS). We conducted a population-based retrospective cohort study of dementia patients during 1 January 1999 to 31 December 2008 using the National Health Insurance Database in Taiwan. New AChEI users during the study period were matched with AChEI nonusers in age-matched and gender-matched cohorts. The risk of ACS associated with use of AChEIs was analyzed using modified Kaplan-Meier analysis and Cox proportional hazard models after adjustment for competing death risk. Use of AChEIs was associated with a lower incidence of ACS (212.8/10,000 person-years) compared to the matched reference cohort (268.7/10,000 person-years). The adjusted hazard ratio for ACS in patients with dementia treated with AChEIs was 0.836 (95% confidence interval, 0.750–0.933; P < 0.001). Further sensitivity analysis of different study populations demonstrated consistent results. A statistical dose–response relationship for AChEI use and ACS risk was significant for the patients with dementia. In patients with dementia, AChEI treatment was associated with decreased risk of ACS.

Highlights

The study aimed to investigate the association of acetylcholinesterase inhibitors (AChEIs) use with the risk of acute coronary syndrome (ACS)
It is conceivable that vascular risk factors would be more prevalent in patients with dementia than in the general population and that the incidence of vascular events would increase in dementia
Patients who received Acetylcholinesterase inhibitors (AChEIs) were more likely to live in a city, were more likely to have hypertension, hyperlipidemia, coronary artery disease, peripheral artery disease, malignancy, or depression, and were less likely to have a history of other underlying diseases, including heart failure, atrial fibrillation, and cerebrovascular disease (Table 1)

Summary

Introduction

The study aimed to investigate the association of acetylcholinesterase inhibitors (AChEIs) use with the risk of acute coronary syndrome (ACS). We conducted a population-based retrospective cohort study of dementia patients during 1 January 1999 to 31 December 2008 using the National Health Insurance Database in Taiwan. Use of AChEIs was associated with a lower incidence of ACS (212.8/10,000 person-years) compared to the matched reference cohort (268.7/10,000 personyears). A statistical dose–response relationship for AChEI use and ACS risk was significant for the patients with dementia. AChEI treatment was associated with decreased risk of ACS. Of ACS is decreased in dementia with AChEIs used For this reason, the study aim was to conduct a nationwide cohort study in Taiwan to investigate the association between AChEI use and risk of ACS

Methods

Results

Conclusion