Heart disease is ranked the second among the leading causes of death in Canada, and approximately 1.3 million of Canadians have heart problems. Drugs used to control blood pressure, cholesterol, and the blood's ability to clot are the most commonly used to prevent heart disease. Their use has led to major drops in deaths related to heart disease, and many patients now live longer despite having had a heart attack.
Elderly patients with heart disease are at risk of Alzheimer's disease, the most common cause of memory loss. Alzheimer's disease patients are treated with anti-Alzheimer's drugs to help slow down memory loss. Besides their beneficial effect in improving patient's memory, these drugs may also help prevent heart attacks and stroke. We have already discovered in mice that two anti-Alzheimer's drugs can reduce the levels of a biochemical that contributes to the stress of the heart, increases blood pressure and induces blood clots. We now want to see if this beneficial effect exists in humans, and specifically, whether these drugs can reduce the risk of new heart attacks, stroke, and death in elderly patients with heart disease.
We think that the use of anti-Alzheimer's drugs could reduce blood pressure and blood clotting that causes stroke and new heart attacks in elderly patients with heart disease. Building on this hypothesis, this project will allow us to find out whether these drugs can be used to prevent new heart attacks, stroke, and death in elderly patients with heart disease. In this study, we will use the largest health records database in the United Kingdom, CPRD to address the research hypothesis. This work will provide clues in how the anti-Alzheimer's drugs affect the heart, and may help identify new ways to prevent stroke and heart attacks. In addition, the drugs that we will be studying are already available in Canada, so the results could have an immediate application on the health of heart-disease patients.
Antiplatelet therapy is the cornerstone of secondary prevention of acute ischemic events in patients with cardiovascular diseases (CVD). Acute and long-term management of patients with CVD has drastically improved their survival; patients live longer on chronic cardiovascular therapy, which creates the potential for drug-drug interactions in the context of polypharmacy, especially in the elderly.
Cognitive impairment and dementia occur in 5% to 10% of people aged >65 years, and affect up to 30% of those >80 years of age. The most common form of dementia, Alzheimer's disease (AD), is treated with anticholinesterases (AChEIs). In addition to their beneficial effects on acetylcholine levels in the brain, our animal research shows that they may also have antiplatelet effects. AChEIs are associated with lower risk of myocardial infarction and death in humans. Furthermore, our published and ongoing work suggests that administration of AChEIs in mice decreases the level of urinary epinephrine, a known sensitizing agent for platelet activity. Therefore, we hypothesize that the use of AChEIs decreases the risk of ischemic stroke, unstable angina, and death, but increases the risk of bleeding in AD patients, especially in those already on antiplatelet therapy
Primary: Bleeding events
- Secondary: Stroke
- Secondary: unstable angina and death
Faleh Tamimi - Chief Investigator - McGill University
Faleh Tamimi - Corresponding Applicant - McGill University
Belinda Nicolaue - Collaborator - McGill University
Faez Al-Hamed - Collaborator - McGill University
Igor Karp - Collaborator - University Of Western Ontario
Iskandar Tamimi - Collaborator - McGill University
Sreenath Arekunnath - Collaborator - McGill University
HES Accident and Emergency;HES Admitted Patient Care;HES Diagnostic Imaging Dataset;HES Outpatient;ONS Death Registration Data