Alzheimer’s drug may lower risk of MI, death

A pharmaceutical used to treat early-stage Alzheimer’s disease may help reduce the risk of MI and death, according to a study published June 5 in the European Heart Journal.

Physicians prescribe cholinesterase inhibitors (ChEIs) to some patients with mild to moderate Alzheimer’s disease to decrease the reduction in the neurotransmitter acetylcholine by blocking the enzyme acetylcholinesterase. ChEIs also appear to have a beneficial effect on the vagus nerve and possibly have an anti-inflammatory effect, too.

Peter Nordstrom, MD, PhD, of Umea University in Umea, Sweden, and colleagues wanted to explore the use of ChEIs and later risk of MIs and death. To do so, they used the Swedish Dementia Registry to identify newly diagnosed Alzheimer’s patients in Sweden. Between May 2007 and December 2011, they found 7,073 records for patients that they linked to other national databases to track ChEIs use, MI diagnoses and deaths. The mean follow-up was 503 days.

Based on the registry data, they determined that 72.9 percent of the patients received ChEIs at least once. Patients receiving the drugs were younger, more likely to be women and less likely to have a history of cardiovascular disease compared with those who did not receive ChEIs. After adjusting for confounders, Nordstrom et al found the ChEI group had a 34 percent lower risk in the composite of MI or death compared with the other group.

In another adjusted analysis, with patients who did not receive ChEIs as a reference point, the risk of the composite of MI or death decreased with increasing dose of ChEIs. Patients prescribed the highest doses had the lowest risk.

“Within the atherosclerotic plaque immune cells produce cytokines that decreases the stability of the plaque, increasing the risk of plaque rupture, and a subsequent MI. Therefore, the documentation of anti-inflammatory properties of ChEIs due to reduced acetylcholine breakdown is of interest,” they wrote.

They added that other studies have also looked at the vagus nerve and ChEIs. “With respect to our results, effects on the cardiac system from ChEI use, such as those found in some of the studies above, could reduce oxygen demands, improve cardiac function, and thereby reduce the risk of MI and death.”

The study is observational. Also, it could be prone to confounding by indication because there were differences between the patients who received ChEIs and those who did not. In a release, Nordstrom recommended a meta-analysis of randomized clinical trials be conducted.