(175) Association of Anticholinergic Burden and Risk of Cardiovascular Events: A Case-Crossover Study

Publication Number: 849

Background: Anticholinergic burden, the cumulative effect of medications with anticholinergic properties, can affect heart rate and rhythm that may lead to adverse outcomes in elderly patients. The association between anticholinergic burden and cardiovascular (CV) events remained uncertain.

Objectives: To evaluate the association between anticholinergic burden and risk of cardiovascular events in the elderly population in Taiwan.

Methods: This was a case-time-control study using data from the Taiwan National Health Insurance Database. We identified the cases aged 65+ years who were hospitalized due to the incident acute CV events, including myocardial infarction, stroke, syncope, conduction disorders, cardiac dysrhythmias, or CV death from 2011 to 2018. The incident CV event was defined as patients without a history of CV events within 5 years prior to the event date. We calculated anticholinergic burden scores based on Anticholinergic Cognitive Burden scale (ACB). We compared the scores within the hazard period (defining as a 30-day period before the event date), with referent period (which was a random selection of a 30-day period between 60 and 180 days before the event). To address the issue of prescription trends of drugs, we selected a 1:1 matched control group without a record of CV event but had same disease risk score (DRS) with each case patient for the control-crossover analysis. We performed conditional logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) to evaluate the difference of scores for anticholinergic burden (3+, 1-2, and 0 point) between hazard and referent periods.

Results: We identified a total of 317,446 case patients. The average age of the cases was 78.4 (SD, 0.01) years. Compared to the score 0 point, we found the ORs were 9.35 (95% CI, 9.15-9.55) and 4.62 (4.52-4.71) for the score 3+ and 1-2, respectively in the case-crossover analysis; the ORs were 1.21 (1.19-1.24) and 1.18 (1.16-1.21) for the score 3+ and 1-2, respectively in the control-crossover analysis. The case-time-control analysis suggested higher scores of anticholinergic burdens were associated with the risk of CV events (OR, 7.72; 95% CI, 7.50-7.94) for score 3+ and (3.91; 3.79-4.03) for score 1-2.

Conclusions: We found higher anticholinergic burden was associated with the increased risk of CV events. The finding warrants clinical attention and strategies to reduce anticholinergic burden to avoid unintended outcomes.