Association between recently raised anticholinergic burden and risk of acute cardiovascular events: nationwide case-case-time-control study

Abstract

Objective To evaluate the association between recently raised anticholinergic burden and risk of acute cardiovascular events in older adults. Design Case-case-time-control study (ie, incorporating a case crossover design and a control crossover design consisting of future cases). Setting Taiwan’s National Health Insurance Research Database. Participants 317 446 adults aged ≥65 who were admitted to hospital because of an incident acute cardiovascular event between 2011 and 2018. Acute cardiovascular events included myocardial infarction, strokes, arrhythmias, conduction disorders, and cardiovascular death. Main outcome measures The anticholinergic burden was measured for each participant by adding up the anticholinergic scores for individual drugs using the Anticholinergic Cognitive Burden Scale. Scores were classified into three levels (0 points, 1-2 points, and ≥3 points). For each participant, anticholinergic burden levels during hazard periods (day −1 to −30 before the cardiovascular event) were compared with randomly selected 30 day reference periods (ie, periods between days −61 and −180). Conditional logistic regression determined odds ratios with 95% confidence intervals to evaluate the association between acute cardiovascular events and recently raised anticholinergic burden. Results The crossover analyses included 248 579 current cases. Participants’ average age on the index date was 78.4 years (standard deviation 0.01), and 53.4% were men. The most frequently prescribed drugs with anticholinergic activity were antihistamines (68.9%), gastrointestinal antispasmodics (40.9%), and diuretics (33.8%). Among patients with varying levels of anticholinergic burden in different periods, more patients carried higher levels of anticholinergic burden during hazard periods than during reference periods. For example, 17 603 current cases had 1-2 points of anticholinergic burden in the hazard period with 0 points in the reference period, while 8507 current cases had 0 points in the hazard period and 1-2 points in the reference period. In the comparison of 1-2 points versus 0 points of anticholinergic burden, the odds ratio was 1.86 (95% confidence interval 1.83 to 1.90) in the case crossover analysis and 1.35 (1.33 to 1.38) in the control crossover analysis, which yielded a case-case-time-control odds ratio of 1.38 (1.34 to 1.42). Similar results were found in the comparison of ≥3 versus 0 points (2.03, 1.98 to 2.09) and ≥3 versus 1-2 points (1.48, 1.44 to 1.52). The findings remained consistent throughout a series of sensitivity analyses (eg, cut-off points for anticholinergic burden categories were redefined and different scales were used to measure anticholinergic burden). Conclusions An association was found between recently raised anticholinergic burden and increased risk of acute cardiovascular events. Furthermore, a greater increase in anticholinergic burden was associated with a higher risk of acute cardiovascular events.

Reducing patient and planetary harms from high anticholinergic burden medication

“…ACB scores can give a useful guide to the risk of anticholinergic adverse events, although they do not consider drug dose, or offer an estimate of individual risk. A 2023 study13 found an association between recently raised anticholinergic burden and increased risk of acute cardiovascular events, with a greater increase in anticholinergic burden conferring higher risk.…”

Cross-Regional Data Initiative for the Assessment and Development of Treatment for Neurological and Mental Disorders

“…For example, Taiwan’s NHIRD with 99.9% coverage of the population received 5 points (ie, very good) for population coverage and follow-up, but only 2 points (ie, poor) for clinical information. 27 …”

“…For example, Taiwan's NHIRD with 99.9% coverage of the population received 5 points (ie, very good) for population coverage and follow-up, but only 2 points (ie, poor) for clinical information. 27 The Common Data Model (CDM) concept means that all data partners convert their native databases to follow standardized data structures and terminologies, allowing the coordinating centre to generate a common analytic program that can be applied to all converted databases. 26 We assessed the essential data in the databases, such as enrollment period, patient characteristics, healthcare facility visit details, diagnosis details and drug details for their convertibility to a general common data model.…”

What is the best first choice oral drug therapy for OAB?

“…More recently Huang et al suggested in a nationwide population based study, an association between recently raised antimuscarinic burden and acute cardiovascular events in older adults 17 …”