Association between recently raised anticholinergic burden and risk of acute cardiovascular events: nationwide case-case-time-control study
Study (n=317,446 adults admitted to hospital with acute CV event) found an association between recently raised anticholinergic burden (using the Anticholinergic Cognitive Burden Scale) and increased risk of acute CV events, with greater burden resulting in higher CV event risk.
Source:
British Medical Journal
SPS commentary:
The most frequently prescribed drugs with anticholinergic activity were antihistamines (68.9%), gastrointestinal antispasmodics (40.9%), and diuretics (33.8%).
A related editorial highlights the study’s findings and notes that clinicians and public health officials should be aware of the potential risks, particularly when prescribing multiple drugs to older adults. It calls for further research and modifications to clinical practice to improve the management of anticholinergic burden in this vulnerable population.
A linked article outlines the issues of exposure time trends in the case crossover design and the implementation of the case-case-time-control design, a control crossover analysis using “future cases” to adjust the exposure time trends. The authors explain that future-case control crossover analysis minimises the influence of constant time confounders, as well as the protopathic bias arising from exposure time trends.