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Antihypertensive drugs and relevant cardiovascular pharmacotherapies and the risk of incident dementia in patients with atrial fibrillation

Wändell, Per LU ; Carlsson, Axel C. ; Sundquist, Jan LU and Sundquist, Kristina LU (2018) In International Journal of Cardiology 272. p.149-154
Abstract

Background: Atrial fibrillation (AF) and dementia are predominant among the elderly; patients with AF have an increased dementia risk. We aimed to study if prescribed antihypertensive drugs and cardiovascular pharmacotherapies are associated with a lower relative risk of dementia. Methods: All included patients were ≥45 years and diagnosed with AF in primary care; 12,096 (6580 men and 5516 women) in Sweden. We excluded patients with a dementia diagnosis before onset of AF. Cox regression was used (hazard ratios, HRs, and 95% confidence interval, CI) with adjustments for sex, age, socioeconomic factors and co-morbidities. Results: Incident dementia occurred in 750 patients (6.2%) during an average of 5.6 years of follow-up (a total of... (More)

Background: Atrial fibrillation (AF) and dementia are predominant among the elderly; patients with AF have an increased dementia risk. We aimed to study if prescribed antihypertensive drugs and cardiovascular pharmacotherapies are associated with a lower relative risk of dementia. Methods: All included patients were ≥45 years and diagnosed with AF in primary care; 12,096 (6580 men and 5516 women) in Sweden. We excluded patients with a dementia diagnosis before onset of AF. Cox regression was used (hazard ratios, HRs, and 95% confidence interval, CI) with adjustments for sex, age, socioeconomic factors and co-morbidities. Results: Incident dementia occurred in 750 patients (6.2%) during an average of 5.6 years of follow-up (a total of 69,214 person-years). Patients prescribed thiazides HR 0.81 (95% CI 0.66–0.99) and warfarin HR 0.78 (95% CI 0.66–0.92) had a lower risk of dementia than patients without these drugs. The use of 1–4 of the different antihypertensive drug classes (thiazides, beta blocker, vessel active calcium channel blockers or renin angiotensin aldosterone (RAAS) blockers) were associated with a reduction of incident dementia; HR 0.80 (95% CI 0.64–1.00) for one to two drugs, and HR 0.63 (95% CI 0.46–0.84) for three or four drugs, versus having no prescribed antihypertensive drugs. The combination of a RAAS-blocker and a thiazide was significant, HR 0.70 (95% CI 0.53–0.92), versus not having that particular combination prescribed, while RAAS-blockers or thiazides separately were not significant. Conclusion: Prescribed antihypertensive drugs, including thiazide/RAAS-blocker combination therapy and use of warfarin, were associated with a decreased incidence of dementia.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
keywords
Antihypertensive drugs, Atrial fibrillation, Dementia, Hypertension
in
International Journal of Cardiology
volume
272
pages
149 - 154
publisher
Elsevier
external identifiers
  • scopus:85050684763
  • pmid:30072151
ISSN
0167-5273
DOI
10.1016/j.ijcard.2018.07.106
language
English
LU publication?
yes
id
13b66951-1a6b-45cb-9d3d-5e4639a572d5
date added to LUP
2018-09-28 14:25:15
date last changed
2024-04-15 12:19:09
@article{13b66951-1a6b-45cb-9d3d-5e4639a572d5,
  abstract     = {{<p>Background: Atrial fibrillation (AF) and dementia are predominant among the elderly; patients with AF have an increased dementia risk. We aimed to study if prescribed antihypertensive drugs and cardiovascular pharmacotherapies are associated with a lower relative risk of dementia. Methods: All included patients were ≥45 years and diagnosed with AF in primary care; 12,096 (6580 men and 5516 women) in Sweden. We excluded patients with a dementia diagnosis before onset of AF. Cox regression was used (hazard ratios, HRs, and 95% confidence interval, CI) with adjustments for sex, age, socioeconomic factors and co-morbidities. Results: Incident dementia occurred in 750 patients (6.2%) during an average of 5.6 years of follow-up (a total of 69,214 person-years). Patients prescribed thiazides HR 0.81 (95% CI 0.66–0.99) and warfarin HR 0.78 (95% CI 0.66–0.92) had a lower risk of dementia than patients without these drugs. The use of 1–4 of the different antihypertensive drug classes (thiazides, beta blocker, vessel active calcium channel blockers or renin angiotensin aldosterone (RAAS) blockers) were associated with a reduction of incident dementia; HR 0.80 (95% CI 0.64–1.00) for one to two drugs, and HR 0.63 (95% CI 0.46–0.84) for three or four drugs, versus having no prescribed antihypertensive drugs. The combination of a RAAS-blocker and a thiazide was significant, HR 0.70 (95% CI 0.53–0.92), versus not having that particular combination prescribed, while RAAS-blockers or thiazides separately were not significant. Conclusion: Prescribed antihypertensive drugs, including thiazide/RAAS-blocker combination therapy and use of warfarin, were associated with a decreased incidence of dementia.</p>}},
  author       = {{Wändell, Per and Carlsson, Axel C. and Sundquist, Jan and Sundquist, Kristina}},
  issn         = {{0167-5273}},
  keywords     = {{Antihypertensive drugs; Atrial fibrillation; Dementia; Hypertension}},
  language     = {{eng}},
  pages        = {{149--154}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Cardiology}},
  title        = {{Antihypertensive drugs and relevant cardiovascular pharmacotherapies and the risk of incident dementia in patients with atrial fibrillation}},
  url          = {{http://dx.doi.org/10.1016/j.ijcard.2018.07.106}},
  doi          = {{10.1016/j.ijcard.2018.07.106}},
  volume       = {{272}},
  year         = {{2018}},
}