Anticholinergic burden (ACB) and risk of acute cardiovascular events

Anticholinergic burden (ACB) and risk of acute cardiovascular events

• study evidence indicates a potential negative impact of medications with anticholinergic properties on mortality and CVD (cardiovascular disease) incidence in middle and older age population (1)
  • compared to people with no anticholinergic burden (ACB=0), people with total ACB >=3 from medications had hazard ratios (HRs) of 1.83(1.53,2.20) and 2.17(1.87,2.52) for mortality and CVD incidence outcomes, respectively, after adjusting for potential confounders
    
    
• Huang et al showed that a recently raised anticholinergic burden was associated with an increased risk of acute cardiovascular events
  • 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
  • a dose-response relation was found between anticholinergic burden and risk of acute cardiovascular events

Anticholinergic burden scores can be a useful way of assessing anticholinergic burden (ACB) (3)

• https://www.acbcalc.com
  • risks of anticholinergics increase with each additional point scored, with an increase in mortality associated with the number and ACB potency of the medication prescribed
    • a combined ACB score of 3+
      • leads to an increased risk of admission for falls and fractures; cognitive decline; dry mouth, constipation, and blurred vision
    • ACB scores can give a useful guide to the risk of anticholinergic adverse events, although they do not consider drug dose, or offer an estimate of individual risk
• consider tapering when stopping anticholinergic medications to avoid withdrawal effects, which may include nausea and sweating

Reference:

• Myint PK, Fox C, Kwok CS, Luben RN, Wareham NJ, Khaw KT. Total anticholinergic burden and risk of mortality and cardiovascular disease over 10 years in 21,636 middle-aged and older men and women of EPIC-Norfolk prospective population study. Age Ageing. 2015 Mar;44(2):219-25.
• Huang W, Yang A S, Tsai D H, Shao S, Lin S, Lai E C et al. Association between recently raised anticholinergic burden and risk of acute cardiovascular events: nationwide case-case-time-control study BMJ 2023; 382 :e076045
• Smith H, Fligelstone H. Reducing patient and planetary harms from high anticholinergic burden medication BMJ 2024; 384 :e075708 doi:10.1136/bmj-2023-075708