胆碱酯酶抑制剂治疗痴呆对心脏起搏器植入风险的影响：一项基于加拿大安大略省卫生行政数据库的回顾性人群研究。
The influence of cholinesterase inhibitor therapy for dementia on risk of cardiac pacemaker insertion: a retrospective, population-based, health administrative databases study in Ontario, Canada.
作者信息
Huang Allen R, Redpath Calum J, van Walraven Carl
机构信息
Division of Geriatric Medicine, Department of Medicine, University of Ottawa, The Ottawa Hospital, Box 678, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.
Arrhythmia Service, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4 W7, Canada.
出版信息
BMC Neurol. 2015 Apr 28;15:66. doi: 10.1186/s12883-015-0325-1.
BACKGROUND
Cholinesterase inhibitors are used to treat the symptoms of dementia and can theoretically cause bradycardia. Previous studies suggest that patients taking these medications have an increased risk of undergoing pacemaker insertion. Since these drugs have a marginal impact on patient outcomes, it might be preferable to change drug treatment rather than implant a pacemaker. This population-based study determined the association of people with dementia exposed to cholinesterase inhibitor medication and pacemaker insertion.
METHODS
We used data from the Ontario health administrative databases from January 1, 1993 to June 30, 2012. We included all community-dwelling seniors who had a code for dementia and were exposed to cholinesterase inhibitors (donezepil, galantamine, and rivastigmine) and/or drugs used to treat co-morbidities of hypertension, diabetes, depression and hypothyroidism. We controlled for exposure to anti-arrhythmic drugs. Observation started at first exposure to any medication and continued until the earliest of pacemaker insertion, death, or end of study.
RESULTS
2,353,909 people were included with 96,000 (4.1%) undergoing pacemaker insertion during the observation period. Case-control analysis showed that pacemaker patients were less likely to be coded with dementia (unadjusted OR 0.42 [95%CI 0.41-0.42]) or exposed to cholinesterase inhibitors (unadjusted OR 0.39 [95%CI 0.37-0.41]). That Cohort analysis showed patients with dementia taking cholinesterase inhibitors had a decreased risk of pacemaker insertion (unadj-HR 0.58 [0.55-0.61]). Adjustment for patient age, sex, and other medications did not notably change results, as did restricting the analysis to incident users.
CONCLUSIONS
Patients taking cholinesterase inhibitors rarely undergo, and have a significantly reduced risk of, cardiac pacemaker insertion.
背景
胆碱酯酶抑制剂用于治疗痴呆症状，理论上可导致心动过缓。既往研究表明，服用这些药物的患者接受起搏器植入的风险增加。由于这些药物对患者预后的影响较小，改变药物治疗可能比植入起搏器更为可取。这项基于人群的研究确定了暴露于胆碱酯酶抑制剂药物的痴呆患者与起搏器植入之间的关联。
方法
我们使用了1993年1月1日至2012年6月30日安大略省卫生管理数据库的数据。我们纳入了所有有痴呆编码且暴露于胆碱酯酶抑制剂（多奈哌齐、加兰他敏和卡巴拉汀）和/或用于治疗高血压、糖尿病、抑郁症和甲状腺功能减退症等合并症的药物的社区居住老年人。我们对暴露于抗心律失常药物进行了控制。观察从首次暴露于任何药物开始，持续到最早的起搏器植入、死亡或研究结束。
结果
纳入2353909人，其中96000人（4.1%）在观察期内接受了起搏器植入。病例对照分析显示，起搏器患者被编码为痴呆的可能性较小（未调整的比值比为0.42[95%置信区间0.41 - 0.42]）或暴露于胆碱酯酶抑制剂的可能性较小（未调整的比值比为0.39[95%置信区间0.37 - 0.41]）。队列分析显示，服用胆碱酯酶抑制剂的痴呆患者起搏器植入风险降低（未调整的风险比为0.58[0.55 - 0.61]）。对患者年龄、性别和其他药物进行调整后，结果没有显著变化；将分析限制在新使用者中也是如此。
结论
服用胆碱酯酶抑制剂的患者很少接受心脏起搏器植入，且植入风险显著降低。
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