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Effects of cardiovascular pharmacotherapies on incident dementia in patients with atrial fibrillation : A cohort study of all patients above 45 years diagnosed with AF in hospitals in Sweden

Wändell, Per LU ; Carlsson, Axel C. ; Li, Xinjun LU ; Sundquist, Jan LU and Sundquist, Kristina LU (2019) In International Journal of Cardiology
Abstract

Background: Patients with atrial fibrillation (AF) have an increased dementia risk dementia. We aimed to study the effect of antihypertensive drugs on dementia in AF patients. Methods: Included patients were ≥45 years diagnosed with AF in Swedish National Patient Register (n = 160,251; 89,723 men and 70,528 women) and alive on January 1, 2007. We excluded patients with dementia before onset of AF. Cox regression was used (hazard ratios, HRs, and 99% confidence interval, CI) with adjustments for sex, age, socioeconomic factors and co-morbidities, using incident dementia diagnosis until December 31, 2015 as outcome. Cardiovascular pharmacotherapies were obtained from the Swedish Prescribed Drug Register. Results: Incident dementia... (More)

Background: Patients with atrial fibrillation (AF) have an increased dementia risk dementia. We aimed to study the effect of antihypertensive drugs on dementia in AF patients. Methods: Included patients were ≥45 years diagnosed with AF in Swedish National Patient Register (n = 160,251; 89,723 men and 70,528 women) and alive on January 1, 2007. We excluded patients with dementia before onset of AF. Cox regression was used (hazard ratios, HRs, and 99% confidence interval, CI) with adjustments for sex, age, socioeconomic factors and co-morbidities, using incident dementia diagnosis until December 31, 2015 as outcome. Cardiovascular pharmacotherapies were obtained from the Swedish Prescribed Drug Register. Results: Incident dementia occurred in 9532 patients (5.9%), 4669 men (5.2%) and 4863 women (6.9%). ARBs were associated with lower risk for all patients (HR 0.87, 99% CI 0.78–0.98), especially in the ages 65–84 years of age (HR 0.87, 99% CI 0.76–0.99). Loop-diuretics were associated with higher risk for all dementia among patients 65–84 years of age (HR 1.16, 99% CI 1.00–1.35), and in the sub-group of other causes of dementia than Alzheimer Disease (AD) and vascular dementia (VaD) (HR 1.14, 99% CI 1.00–1.30), but with a lower risk in the sub-group of AD and VaD (HR 0.81, 99% CI 0.68–0.95). Conclusion: ARBs were associated with a decreased incidence of dementia, and loop diuretics with a higher risk in general but lower risk in the AD and VaD sub-group. ARBs could have specific advantages in prevention of dementia, but the results need confirmation in further studies.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Antihypertensive drugs, Atrial fibrillation, Dementia, Gender, Hypertension
in
International Journal of Cardiology
publisher
Elsevier
external identifiers
  • scopus:85073157365
ISSN
0167-5273
DOI
10.1016/j.ijcard.2019.09.065
language
English
LU publication?
yes
id
1fc92f0e-4cbf-43ab-9f0f-c39779341305
date added to LUP
2019-10-25 12:01:11
date last changed
2019-11-25 09:35:22
@article{1fc92f0e-4cbf-43ab-9f0f-c39779341305,
  abstract     = {<p>Background: Patients with atrial fibrillation (AF) have an increased dementia risk dementia. We aimed to study the effect of antihypertensive drugs on dementia in AF patients. Methods: Included patients were ≥45 years diagnosed with AF in Swedish National Patient Register (n = 160,251; 89,723 men and 70,528 women) and alive on January 1, 2007. We excluded patients with dementia before onset of AF. Cox regression was used (hazard ratios, HRs, and 99% confidence interval, CI) with adjustments for sex, age, socioeconomic factors and co-morbidities, using incident dementia diagnosis until December 31, 2015 as outcome. Cardiovascular pharmacotherapies were obtained from the Swedish Prescribed Drug Register. Results: Incident dementia occurred in 9532 patients (5.9%), 4669 men (5.2%) and 4863 women (6.9%). ARBs were associated with lower risk for all patients (HR 0.87, 99% CI 0.78–0.98), especially in the ages 65–84 years of age (HR 0.87, 99% CI 0.76–0.99). Loop-diuretics were associated with higher risk for all dementia among patients 65–84 years of age (HR 1.16, 99% CI 1.00–1.35), and in the sub-group of other causes of dementia than Alzheimer Disease (AD) and vascular dementia (VaD) (HR 1.14, 99% CI 1.00–1.30), but with a lower risk in the sub-group of AD and VaD (HR 0.81, 99% CI 0.68–0.95). Conclusion: ARBs were associated with a decreased incidence of dementia, and loop diuretics with a higher risk in general but lower risk in the AD and VaD sub-group. ARBs could have specific advantages in prevention of dementia, but the results need confirmation in further studies.</p>},
  author       = {Wändell, Per and Carlsson, Axel C. and Li, Xinjun and Sundquist, Jan and Sundquist, Kristina},
  issn         = {0167-5273},
  language     = {eng},
  publisher    = {Elsevier},
  series       = {International Journal of Cardiology},
  title        = {Effects of cardiovascular pharmacotherapies on incident dementia in patients with atrial fibrillation : A cohort study of all patients above 45 years diagnosed with AF in hospitals in Sweden},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2019.09.065},
  doi          = {10.1016/j.ijcard.2019.09.065},
  year         = {2019},
}