Rampa Lorenzo, Santangelo Roberto, Gaspardone Carlo, Cerutti Alice, Magnani Giuseppe, Piscazzi Francesco, Sgherzi Giulia, Fiore Giorgio, Filippi Massimo, Agosta Federica, Margonato Alberto, Fragasso Gabriele
Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy; Cardiothoracic Department, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
Neurology Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.
Am J Cardiol. 2023 Aug 1;200:162-170. doi: 10.1016/j.amjcard.2023.05.041. Epub 2023 Jun 14.
In patients with mild to moderate dementia, acetylcholinesterase inhibitors (AChE-I) are used to improve cognitive functions, but bradycardia, conduction abnormalities, and hypotension are possible side effects because of the peripheral muscarinic M2 receptor stimulation. This study aimed to evaluate the main cardiologic clinical outcomes in patients with dementia who are on AChE-I. In this retrospective, monocentric, observational cohort study, 2 groups were considered: (1) patients with dementia because of the typical and atypical forms of Alzheimer disease treated with AChE-I and (2) cognitively unimpaired, matched control group. The primary end point was a composite of cardiovascular death, nonfatal acute myocardial infarction, myocardial revascularization, occurrence of stroke and/or transient ischemic attacks, and hospitalization for heart failure occurring during a mean of 3.1 years of follow-up. The secondary end points were each individual component of the primary end point, total mortality, noncardiovascular death, and incidence of pacemaker implant. Each group included 221 patients who were homogeneous in terms of age, gender, and main cardiovascular risk factors. Major adverse cardiovascular events occurred in 24 patients with dementia (2.1 per 100 patient-years) compared with 56 in control group (5.0 per 100 patient-years), p = 0.036. Even if not significant, the difference was mainly driven by myocardial revascularization (3.2% vs 6.8%) and hospitalization for heart failure (4.5% vs 14.5%). As expected, noncardiovascular mortality was significantly higher in the treatment group (13.6% vs 2.7% p = 0.006). No significant difference between the groups was observed in terms of other secondary outcomes. In conclusion, in patients with dementia, the use of AChE-I may be protective for cardiovascular outcomes, especially in reducing heart failure hospitalization and myocardial revascularization.
在轻度至中度痴呆患者中，乙酰胆碱酯酶抑制剂（AChE-I）用于改善认知功能，但由于外周毒蕈碱M2受体受刺激，心动过缓、传导异常和低血压是可能的副作用。本研究旨在评估使用AChE-I的痴呆患者的主要心脏临床结局。在这项回顾性、单中心、观察性队列研究中，考虑了2组：（1）因典型和非典型阿尔茨海默病形式而接受AChE-I治疗的痴呆患者，以及（2）认知未受损的匹配对照组。主要终点是在平均3.1年的随访期间发生的心血管死亡、非致命性急性心肌梗死、心肌血运重建、中风和/或短暂性脑缺血发作以及因心力衰竭住院的综合情况。次要终点是主要终点的各个单独组成部分、总死亡率、非心血管死亡以及起搏器植入发生率。每组包括221例在年龄、性别和主要心血管危险因素方面同质的患者。24例痴呆患者发生了主要不良心血管事件（每100患者年2.1例），而对照组为56例（每100患者年5.0例），p = 0.036。即使不显著，差异主要由心肌血运重建（3.2%对6.8%）和因心力衰竭住院（4.5%对14.5%）驱动。正如预期的那样，治疗组的非心血管死亡率显著更高（13.6%对2.7%，p = 0.006）。在其他次要结局方面，两组之间未观察到显著差异。总之，在痴呆患者中，使用AChE-I可能对心血管结局具有保护作用，尤其是在减少心力衰竭住院和心肌血运重建方面。
