Which Cholinesterase Inhibitor is the Safest for the Heart in Elderly Patients With Alzheimer’s Disease?

Abstract

It was demonstrated that none of the 3 ChEIs were associated with increased negative chronotropic, arrhythmogenic, and hypotensive effects for the elderly patients with AD.

Cardiovascular Outcomes of Cholinesterase Inhibitors in Individuals with Dementia: A Meta‐Analysis and Systematic Review

“…Regarding outcomes, hypertension was defined according to objective measurement in 9 studies. [13][14][15][16][23][24][25][26]33 Bradycardia and heart rate changes were evaluated according to objective measurement in 17 studies, 13,[15][16][17]19,[22][23][24][25][26][27][28][29][30][31]33,34 and one study reported data on bradycardia from a database. 32 After a median follow-up of 24 weeks (range 3-463 weeks), AChEI use was associated with a higher proportion of hypertension in 7 studies compared to baseline (1,573 individuals, 4%, 95% CI52-8%, p<.001, I 2 547%) and bradycardia in 12 studies (13,703 participants, 2%, 95% CI51-6%, p<.001, I 2 598%).…”

Cardiovascular Effects of Drugs Used to Treat Alzheimer’s Disease

“…In summary, although uncommon, ACHI therapy appears to be associated with about a 1.5-2 fold risk of developing bradycardia. The vast majority of patients receiving ACHIs will have normal ECGs and no significant hemodynamic changes [18][19][20]. There is insufficient data to determine whether there are differences between the individual class members of ACHIs and the risk of bradycardia as most of the data relate to donepezil therapy [19].…”

Asymptomatic Bradycardia Due to Rivastigmine in an Elderly Adult with Lewy Body Dementia

“…The remarkable thing about this case is the development of asymptomatic bradycardia due to rivastigmine use. Although ChEIs are safe for the cardiac system, a limited number of case reports indicate development of atrioventricular block during rivastigmine therapy. In one of them, the relationship between development of third‐degree atrioventricular block and rivastigmine therapy could not be demonstrated definitely because cardiac biomarkers were higher than normal in both cases and ischemic etiology could not be fully clarified .…”

“…Although the brain is the main target organ of rivastigmine therapy, cardiac muscle tissue, which is rich in cholinesterase, could be adversely affected. Potential cardiac adverse events, including bradycardia, cardiac block, and prolonged QT, may result from vagotonic effects of ChEIs, but a limited number of studies have demonstrated that ChEIs, including rivastigmine, are safe for the cardiac system . Nevertheless, there are a few case reports of rivastigmine‐induced bradycardia in the literature .…”