Cholinesterase inhibitors – lower risk of heart attack and death in Alzheimer’s disease patients

The group of drugs used in Alzheimer’s disease therapy are cholinesterase inhibitor(ChEI). It turns out that their influence on cranial nerve X and anti-inflammatory action may be useful in prophylaxis of cardiovascular diseases. Authors of a research published in European Heart Journal have shown that ChEI intake may significantly decrease the risk heart attack and death.

Alzheimer’s disease (AD) is one of the most frequent causes of dementia occurrence in elderly people. About 30 millions of people worldwide suffers from the disease. In Poland estimated spread of dementia in people aged 65 or more is about 500 – 700 thousand and has increasing tendency.

In the beginning the disease develops asymptomatically. After a period of 5-12 years impairment and gradual loss of memory and cognitive function appear. Apart from personality changes and confusion, such people suffer from the paralysis of anus and bladder sphincter and gait disorders which prevents the diseased from independent functioning.

One of the best proved hypothetical AD’s pathomechanisms are disorders of cholinergic neurotransmission. Elementary group of drugs used in treatment of cognitive function disorders in AD patients are ChEI. Their action consists in blocking an enzyme which is responsible for acetylcholine hydrolysis in synapse thus increasing its availability for muscarinic and nicotinic cholinergic receptors. Reversible, pseudo-irreversible, or irreversible cholinesterase inhibitors are distinguished. In Poland, currently registered ChEI are: donepezil, rivastigmine and galantamine. According to research these medicaments are comparatively effective in reduction of cognitive, behavioural and functioning deficits especially in the early stage of the disease.

The research was conducted by Peter Nordström et al. from Umeå in Switzerland. They subjected a group of 7073 people suffering from Alzheimer’s disease or mixed dementia in AD. Researched were included in Swedish Dementia Registry from 2007 and their average age was 79. The data concerning heart attack and death occurrence were obtained from national registries.

The observation lasted for 503 days. After the data analysis it turned out that ChEI intake decreased the risk of heart attack by 38% and death by 36%.What is more, people taking the highest doses of cholinesterase inhibitors (10 mg of donepezil, >6 mg of rivastigmine, 24 mg of galantamine) were in 65% less risk to heart attack and 44% less prone to death.

The data confirm positive effects of ChEI on cardiovascular system. It was shown that cholinesterase inhibitors decrease the risk of heart attack and death depending on doses. Significant vagotonic and anti-inflammatory influence of AChEI is the most probable cause of this situation.

Written by: Anna Szajerska, Karolina Gasińska, Łukasz Kurasiewicz

Source:
1. Nordstrom P, Religa D, Wimo A, et al. The use of cholinesterase inhibitors and the risk of myocardial infarction and death: a nationwide cohort study in subjects with Alzheimer’s disease. Eur Heart J. 2013; 34:258591.
2. N.-H. Trinh, J. Hoblyn, S. Mohanty, et al.; Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis. JAMA. 2003; 289. s.210-216.
3. Serge G. Gauthier. Alzheimer’s disease: the benefits of early treatment. European Journal of Neurology. 2005; 12(3) s.11–16.
4. Bartoszewska M. Molecular mechanisms of Alzheimer’s disease. Postępy biologii komórki. 2008. 35(3) s. 333-350.
5. Leszek J. Alzheimer’s disease: pathogenesis, diagnostics, pharmacotherapy of cognitive disorders Psychiatria w Praktyce Ogólnolekarskiej. 2002. 2(2).
6. Zabłocka A. Alzheimer’s disease as neurodegenerative disorder. Postepy Hig Med Dosw. 2006; 60. s. 209-216.

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