Association Between Anticholinergic Burden and the Risk of Cardiovascular Events in Older Adults: A Systematic Review and Meta-Analysis
Author(s)
Cheng-Yi Ting, PharmD, BSc1, Shao-En Weng, MSc2, Shih-Tsung Huang, PharmD, PhD1.
1Pharmacy, National Yang Ming Chiao Tung University, Taipei City, Taiwan, 2Taipei City Hospital Zhongxing Branch, Taipei City, Taiwan.
1Pharmacy, National Yang Ming Chiao Tung University, Taipei City, Taiwan, 2Taipei City Hospital Zhongxing Branch, Taipei City, Taiwan.
Presentation Documents
OBJECTIVES: Recent studies suggest anticholinergic drug burden (ACB) may increase cardiovascular risks in older adults. However, current research remains limited by heterogeneous outcomes and methodological constraints. This systematic review and meta-analysis aimed to evaluate the associations between ACB and the risk of cardiovascular events in older adults.
METHODS: Databases including PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials, case-control and cohort studies until October 31, 2024. Anticholinergic burden was quantified using validated rating scales, primarily the ACB scale. Cardiovascular events (stroke, myocardial infarction, arrhythmias, heart failure, and cardiovascular deaths) were analyzed as both composite outcomes and individual event types. Meta-analysis was performed using a random-effects model to examine the association between ACB and cardiovascular events, with results expressed as odds ratios (OR) and hazard ratios (HR). Study quality and heterogeneity were assessed through subgroup analyses, including dose-effect evaluation of anticholinergic burden levels and cardiovascular outcomes.
RESULTS: We included a total of 7 studies (6 cohort studies and 1 case-case-time-control study) with 906,706 participants. The meta-analysis demonstrated that anticholinergic burden quantified by ACB was significantly associated with increased risk of composite cardiovascular outcomes (HR 1.41, 95% CI 1.17-1.69; OR 1.65, 95% CI 1.12-2.43), stroke (OR 1.50, 95% CI 1.20-1.87), and cardiovascular deaths (OR 2.09, 95% CI 1.76-2.47). Dose-effect evaluation revealed high anticholinergic burden (ACB score ≥3) significantly increased risk for composite cardiovascular outcomes (OR 1.56, 95% CI 1.05-2.32) and stroke (OR 1.71, 95% CI 1.40-2.08), while moderate-to-high burden (ACB score ≥2) increased composite cardiovascular outcomes (OR 2.20, 95% CI 1.36-3.56).
CONCLUSIONS: Anticholinergic burden, quantified by ACB, is associated with increased cardiovascular risk in older adults, demonstrating a clear dose-response relationship. Clinicians should carefully consider anticholinergic medication burden when developing treatment plans for older adults to mitigate the risk of cardiovascular adverse events and prevent deterioration of cardiovascular function.
METHODS: Databases including PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials, case-control and cohort studies until October 31, 2024. Anticholinergic burden was quantified using validated rating scales, primarily the ACB scale. Cardiovascular events (stroke, myocardial infarction, arrhythmias, heart failure, and cardiovascular deaths) were analyzed as both composite outcomes and individual event types. Meta-analysis was performed using a random-effects model to examine the association between ACB and cardiovascular events, with results expressed as odds ratios (OR) and hazard ratios (HR). Study quality and heterogeneity were assessed through subgroup analyses, including dose-effect evaluation of anticholinergic burden levels and cardiovascular outcomes.
RESULTS: We included a total of 7 studies (6 cohort studies and 1 case-case-time-control study) with 906,706 participants. The meta-analysis demonstrated that anticholinergic burden quantified by ACB was significantly associated with increased risk of composite cardiovascular outcomes (HR 1.41, 95% CI 1.17-1.69; OR 1.65, 95% CI 1.12-2.43), stroke (OR 1.50, 95% CI 1.20-1.87), and cardiovascular deaths (OR 2.09, 95% CI 1.76-2.47). Dose-effect evaluation revealed high anticholinergic burden (ACB score ≥3) significantly increased risk for composite cardiovascular outcomes (OR 1.56, 95% CI 1.05-2.32) and stroke (OR 1.71, 95% CI 1.40-2.08), while moderate-to-high burden (ACB score ≥2) increased composite cardiovascular outcomes (OR 2.20, 95% CI 1.36-3.56).
CONCLUSIONS: Anticholinergic burden, quantified by ACB, is associated with increased cardiovascular risk in older adults, demonstrating a clear dose-response relationship. Clinicians should carefully consider anticholinergic medication burden when developing treatment plans for older adults to mitigate the risk of cardiovascular adverse events and prevent deterioration of cardiovascular function.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD228
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Geriatrics