Cholinesterase inhibitors (ChEIs), drugs used to treat Alzheimer’s disease during its early stages, were found to be linked to reducing risk of myocardial infarction (MI) and death, according to a study published June 4 in the European Heart Journal.

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The study, which looked as ChEIs, such as donepezil, rivastigmine and galantamine, consisted of 7,073 participants from the Swedish Dementia Registry who had been diagnosed with Alzheimer's dementia or Alzheimer's mixed dementia. Results showed that the participants who had been taking ChEIs had a 36 percent reduced risk of death from any cause [hazard ration (HR): 0.64, 95 percent confidence interval (CI) 0.54-0.76], a 38 percent reduced risk of a MI [HR: 0.62, 95 percent CI: 0.40-0.95] and a 26 percent reduced risk of death from cardiovascular causes compared to those not taking ChEIs.

Additionally, the study found that the participants who were taking the highest recommended ChEI doses (donepezil 10 mg, rivastigmine > 6 m, galantamine 24 mg) had the lowest risk of MI (HR: 0.35, 95 percent CI: 0.19 – 0.64), as well as the lowest risk of death (HR: 0.54, 95 percent CI: 0.43 – 0.67) compared to those who had never used ChEIs.

"If you translate these reductions in risk into absolute figures, it means that for every 100,000 people with Alzheimer's disease, there would be 180 fewer heart attacks (295 as opposed to 475) and 1,125 fewer deaths from all causes (2,000 versus 3,125) every year among those taking ChEIs compared to those not using them," the authors note.

Although the results of this study link the use of ChEIs with a reduced risk of heart attacks and deaths from cardiovascular disease in general or from any cause, the authors note that "as this is an observational study, we cannot say that ChEI use is causing the reduction in risk, only that it is associated with a reduction. However, the strengths of the associations make them very interesting from the clinical point of view, although no clinical recommendation should be made on the basis of the results from our study. It would be of great value if a meta-analysis of previous, randomized controlled trials could be performed, as this might produce answers on which clinical recommendations could be based."

Keywords: Myocardial Infarction, Piperidines, Cholinesterase Inhibitors, Dementia, Indans, Cardiovascular Diseases, Confidence Intervals, Phenylcarbamates

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