Medications commonly used to treat Alzheimer's disease may have another benefit: they may reduce the risk of having a heart attack.
Drugs like donepezil (brand name Aricept), rivastigmine (Exelon) and galantamine (Reminyl) are commonly given to those in the earlier stages of Alzheimer’s to ease symptoms, though their benefits are modest at best and they do nothing to stop the relentless progression of disease. Researchers who looked at more than 7,000 people with Alzheimer’s living in Sweden found that those taking the drugs were 38 percent less likely to have a heart attack. They were also less likely to die from stroke or, indeed, to die from any cause. People who were taking the highest recommended doses of the drugs had the lowest risk of heart attack: 65 percent lower than those who had never taken them.
The drugs are known as cholinesterase inhibitors because they inhibit the actions of a specific enzyme in the brain. The researchers speculate that they may have cardiovascular benefits because they reduce inflammation, which is increasingly recognized as a factor in Alzheimer’s disease onset. Cholinesterase inhibitors also affect the vagus nerve, a major nerve that controls heart rate.
The heart benefits of the drugs were evident even after the researchers controlled for factors like age, sex, and whether people had Alzheimer’s disease or forms of dementia linked to blood vessel disease in the brain. They also controlled for the quality of medical care that people received, as well as medications they may have been taking for other medical problems.
The benefits of the drugs, though, were fairly modest. Peter Nordstrom of Umea University in Sweden noted that for every 100,000 people with Alzheimer’s disease taking one of these drugs, there would be 180 fewer heart attacks per year: 295 versus 475. There would also be 1,125 fewer deaths: about 2,000 versus 3,125.
People in the study who were taking memantine (Namenda), which is commonly prescribed for more advanced Alzheimer’s and which is not a cholinesterase inhibitor, did not experience fewer heart attacks or deaths.
Professor Nordstrom noted that because this was an observational study, rather than a placebo-controlled trial, “we cannot say that cholinesterase inhibitor 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.” He cautioned, however, that the drugs should not be taken as a way to promote heart health until further research is done.
Source: Peter Nordström, Dorota Religa, Anders Wimo, Bengt Winblad, and Maria Eriksdotter: “The use of cholinesterase inhibitors and the risk of myocardial infarction and death: a nationwide cohort study in subjects with Alzheimer's disease." European Heart Journal, doi:10.1093/eurheartj/eht182, May 2013.