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Antihypertensive drugs and relevant cardiovascular pharmacotherapies and the risk of incident dementia in patients with atrial fibrillation
Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Alfred Nobels Alle 23, S-14183 Huddinge, Sweden.ORCID iD: 0000-0001-5169-2965
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Alfred Nobels Alle 23, S-14183 Huddinge, Sweden.
Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Family Med & Community Hlth, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA;Shimane Univ, Sch Med, Dept Funct Pathol, Ctr Community Based Healthcare Res & Educ CoHRE, Matsue, Shimane, Japan.
Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Family Med & Community Hlth, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA;Shimane Univ, Sch Med, Dept Funct Pathol, Ctr Community Based Healthcare Res & Educ CoHRE, Matsue, Shimane, Japan.
2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 272, p. 149-154Article in journal (Refereed) Published
Abstract [en]

Background: Atrial fibrillation (AF) and dementia arc 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 anlihy-pertensive 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.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2018. Vol. 272, p. 149-154
Keywords [en]
Atrial fibrillation, Dementia, Anti hypertensive drugs, Hypertension
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-367013DOI: 10.1016/j.ijcard.2018.07.106ISI: 000446025200030PubMedID: 30072151OAI: oai:DiVA.org:uu-367013DiVA, id: diva2:1266517
Funder
Swedish Research Council, 2014-02517Swedish Research Council, 2014-10134Swedish Research Council, 2016-01176Available from: 2018-11-28 Created: 2018-11-28 Last updated: 2018-11-28Bibliographically approved

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