乙酰胆碱酯酶抑制剂与痴呆患者中风和死亡的风险。
Acetylcholinesterase inhibitors and risk of stroke and death in people with dementia.
机构信息
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
出版信息
Alzheimers Dement. 2018 Jul;14(7):944-951. doi: 10.1016/j.jalz.2018.02.011. Epub 2018 Apr 26.
INTRODUCTION
The aim of this study was to investigate the association between acetylcholinesterase inhibitor (AChEI) use and risk of ischemic stroke and death in people with dementia.
METHODS
A cohort study of 44,288 people with dementia registered in the Swedish Dementia Registry from 2007 to 2014. Propensity score-matched competing risk regression models were used to compute hazard ratios and 95% confidence intervals for the association between time-dependent AChEI use and risk of stroke and death.
RESULTS
Compared with matched controls, AChEI users had a lower risk of stroke (hazard ratio: 0.85, 95% confidence interval: 0.75-0.95) and all-cause death (hazard ratio: 0.76, 95% confidence interval: 0.72-0.80). After considering competing risk of death, high doses (≥1.33 defined daily doses) of AChEI remained significantly associated with reduced stroke risk.
DISCUSSION
The use of AChEIs in people with dementia may be associated with reduced risk of ischemic stroke and death. These results call for a closer examination of the cardiovascular effects of AChEIs.
简介
本研究旨在探讨乙酰胆碱酯酶抑制剂（AChEI）在痴呆患者中的应用与缺血性卒中及死亡风险之间的关系。
方法
这是一项队列研究，纳入了 2007 年至 2014 年间在瑞典痴呆症登记处登记的 44288 名痴呆患者。采用倾向评分匹配竞争风险回归模型，计算时间依赖性 AChEI 使用与卒中及死亡风险之间的关联的风险比和 95%置信区间。
结果
与匹配对照组相比，AChEI 使用者卒中风险较低（风险比：0.85，95%置信区间：0.75-0.95），全因死亡风险也较低（风险比：0.76，95%置信区间：0.72-0.80）。在考虑死亡的竞争风险后，高剂量（≥1.33 定义日剂量）的 AChEI 与卒中风险降低仍显著相关。
讨论
痴呆患者使用 AChEI 可能与缺血性卒中及死亡风险降低相关。这些结果呼吁更密切地关注 AChEI 的心血管作用。
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