Medications that are prescribed for early-stage Alzheimer’s disease appear to reduce the risk of heart attack and early death, researchers from Umeå University, Umeå, Sweden, reported in the European Heart Journal.

Professor Peter Nordström and team examined data related to ChEls (cholinesterase inhibitors), including galantamine, rivastigmine and donepezil, all medications used for the treatment of mild-moderate Alzheimer’s disease.

Cholinesterase inhibitors raise the level of the neurotransmitter acetylcholine. Alzheimer’s patients and people with related conditions have lower levels of acetylcholine. Raising acetylcholine levels slows down mental decline in people with Alzheimer’s disease.

Among the side effects associated with ChEIs, is a beneficial effect on the vagus nerve. The vagus nerve controls our heartbeat. The authors explained that previous studies had suggested that ChEIs might also help reduce inflammation.

The scientists followed 7,073 patients with Alzheimer’s disease from May 2007 to December 2010. Their details were stored on the Swedish Dementia Registry.

Patients on ChEIs were found to have:

  • a 36% lower risk of death from any cause
  • a 48% lower risk of heart attack (myocardial infarction)
  • a 26% lower risk of death from stroke and other cardiovascular diseases

The authors wrote that they came to these figures after making adjustments for several confounding factors, including sex, age, Alzheimer’s dementia diagnosis, mixed dementia diagnosis, level of care, and medical history (including medications for other conditions and illnesses).

Prof Nordström explained:

“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 1125 fewer deaths from all causes – 2000 versus 3125 – every year among those taking ChEIs compared to those not using them.”

Patients taking the highest ChEls doses had a 65% lower risk of heart attack and a 46% lower risk of death compared to those who never used the drug.

The team then checked to see whether any of the other dementia medications might be providing protection from heart attack or early death. They found that Memantine made no difference. Memantine is prescribed for patients with moderate to advanced Alzheimer’s and works differently from ChEls.

Nordström said: “As far as we know, this is the first time that the use of ChEIs has been linked to a reduced risk of heart attacks and deaths from cardiovascular disease in general or from any cause. 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 recommendations should be made on the basis of the results from our study. It would be of great value if a meta-analysis of previous, randomised controlled trials could be performed, as this might produce answers on which clinical recommendations could be based.”

This study was based on a nationally-representative group of patients, Nordström added. So, it should be possible to extrapolate the findings to other parts of the world.

In December 2012, researchers reported that galantamine, a cholinesterase inhibitor, lowers mortality significantly in patients with mild to moderately severe Alzheimer’s disease. Not only does galantamine reduce mortality rates, it also slows down cognitive decline, according to a study which compared it to a placebo.

Written by Christian Nordqvist