Reduce Risk of Dementia by Combining Cardiovascular Disease Drug Classes

Long-term combinatorial use of antihypertensives, diuretics, lipid-lowering drugs (LLDs), or oral anticoagulants (OACs) decreases risk of dementia, according to study results in Alzheimer’s & Dementia.

Previous studies have identified that single cardiovascular disease (CVD) drug classes were associated with lower risk for dementia. In the current study, researchers aimed to explore this relationship with multiple CVD drugs.

Data for this case-control study were sourced from national population registers in Sweden. Individuals diagnosed with dementia between 2011 and 2016 at 70 years of age or older were matched with 10 non-dementia control individuals. Risk of dementia was assessed on the basis of antiplatelet, b-blocker, calcium channel blocker (CCB), diuretic, lipid-lowering drug, OAC, and/or renin–angiotensin system (RAS)–acting agent use since 2005. Long-term use was defined as 5 years or longer.

In total, there were 88,065 dementia diagnosis cases and 880,650 matched control individuals. The two groups both comprised 59.0% women and both had a mean (SD) age of 84.2 (6.4). Additionally, 51.8% and 50.6% had less than a high school education, 45.6% and 42.3% had hypertension, 20.9% and 18.2% had atrial fibrillation, and 20.8% and 19.5% had coronary heart disease, respectively.

Compared with nonuse, risk of dementia was higher with use of diuretics, b-blockers, CCBs, RAS-acting agents, and LLDs for 1 to 4 years (adjusted odds ratio [aOR] range, 1.13-1.30). In comparison, this risk was lower with use for 5 to 9 (aOR range, 0.84-0.96) and 10 or more (aOR range, 0.75-0.87) years. Conversely, compared with no use, use of antiplatelets for one to 4 (aOR, 1.25; 95% CI, 1.21-1.28), 5 to 9 (aOR, 1.18; 95% CI, 1.16-1.21), or 10 or more (aOR, 1.13; 95% CI, 1.09-1.18) years was associated with elevated dementia risk.

In the drug combination analysis, dementia risk was significantly reduced with long-term use of 3 (aOR, 0.70; 95% CI, 0.60-0.80), 2 (aOR, 0.73; 95% CI, 0.68-0.78), or one (aOR, 0.84; 95% CI, 0.81-0.88) antihypertensive medications relative to no cardiovascular disease medications. In addition, dementia risk was lower with the combination of long-term use of one antihypertensive medication plus diuretics, LLDs, or OACs (aOR range, 0.74-0.84) or 2 or more antihypertensive medications plus diuretics, LLDs, antiplatelets, or OACs (aOR range, 0.66-85) compared with no cardiovascular drugs. Long-term use of OACs, antiplatelets, and LLDs on their own did not lower risk for dementia but use of diuretics on their own did (aOR, 0.87; 95% CI, 0.83-0.92).

In sensitivity analyses, dementia risk trends were similar for the drug use duration analysis when patients who used the CVD medications prior to 2006 were excluded.

The researchers concluded, “Our results show a lower risk of dementia diagnosis associated with long-term use (≥ 5 years) of most cardiovascular drug classes…as well as common combinations of these drugs. However, antiplatelets are associated with an increased dementia risk, particularly when used alone.”

This study was limited by the cross-sectional design, which did not allow for an evaluation of causal relationships.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor