Friday, September 29, 2023

Anticholinergic medicines linked to cardiovascular events in older adults

  1. Tou-Yuan Tsai, emergency physician12,
  2. Ching-Hui Loh, professor of geriatric medicine23,
  3. Huei-Kai Huang, physician-scientist24
  1. 1Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
  2. 2School of Medicine, Tzu Chi University, Hualien, Taiwan
  3. 3Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
  4. 4Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
  1. Correspondence to: H-K Huang drhkhuang{at}

Assessment of overall anticholinergic burden is essential for patients taking multiple medicines

Polypharmacy is prevalent among older adults aged ≥65 years and often leads to unintended clinical consequences. Drugs with anticholinergic activity are frequently prescribed to older adults for a range of conditions, such as respiratory, cardiovascular, gastrointestinal, and genitourinary diseases, and mental disorders. However, anticholinergic activity is often considered an unwanted side effect, causing adverse events such as urinary retention, mouth dryness, constipation, cognitive decline, and falls.123

Previous epidemiological studies indicate that about 20-50% of older adults regularly receive drugs with anticholinergic effects, and one third to one half of the drugs commonly prescribed to older adults exhibit potential anticholinergic activity.34 Therefore, recognising the anticholinergic burden and its potential negative impacts on older people is important clinically. The linked study by Huang and colleagues (doi:10.1136/bmj-2023-076045) contributes to a growing body of evidence by establishing an association between recently increased anticholinergic burden and a heightened risk of acute cardiovascular events, including myocardial infarction, stroke, arrhythmia, and cardiovascular death in older adults.5

Using nationwide population …

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