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Use of rivastigmine or galantamine and risk of adverse cardiac events: a database study from the Netherlands.
MedLine Citation:
PMID:  23217530     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Two cholinesterase inhibitors (ChEIs), rivastigmine and galantamine, are used to treat Alzheimer disease in the Netherlands. Several adverse cardiac events have been reported for these medications.
OBJECTIVE: We aimed to assess if the use of ChEIs increased the risk of cardiac events in the Netherlands.
METHODS: A cohort crossover study of the PHARMO Record Linking System database included patients who initiated ChEIs at age 50 years or older, had at least 1 dispensing of a ChEI drug between 1998 and 2008, a 1-year history in PHARMO, and 1 subsequent dispensing of any medication. Two outcomes were assessed: a first hospitalization for syncope or atrioventricular block. Poisson and Cox regression were used to calculate incidence densities and hazard ratios for cardiac events during periods with ChEI use, compared with periods without ChEI use.
RESULTS: During the complete observation period of 8.9 years (interquartile range 6.7 to 10.2) there were 132 first hospitalizations for atrioventricular block and 17 first hospitalizations for syncope among 3358 patients. The adjusted incidence densities were significantly increased during ChEI exposure for syncope and atrioventricular block, when compared with the background incidence densities in the roughly 5 years before the last year before ChEI initiation. However, when exposed periods were compared with the unexposed periods 1 year before ChEI initiation and times after exposure, the adjusted hazard ratios remained increased for syncope and atrioventricular block, but increases were not significant anymore.
CONCLUSIONS: Exposure to ChEIs might increase the risk of adverse cardiac events, but small numbers of cases limit conclusions about the risk in this population and research on larger study samples is needed.
Authors:
Edeltraut Kröger; Mieke Berkers; Pierre-Hugues Carmichael; Patrick Souverein; Rob van Marum; Toine Egberts
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of geriatric pharmacotherapy     Volume:  10     ISSN:  1876-7761     ISO Abbreviation:  Am J Geriatr Pharmacother     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101190325     Medline TA:  Am J Geriatr Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  373-80     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.
Affiliation:
Centre d'excellence sur le vieillissement de Québec, Centre de recherche FRQ-S du CHU universitaire de Québec, Québec, Canada. Electronic address: edeltraut.kroger.cha@ssss.gouv.qc.ca.
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