Drug Burden & Heart Health: Long-Term Risks & Monitoring

A growing body of research suggests a link between long-term use of medications with anticholinergic effects and an increased risk of cardiovascular events. A new study, published February 28, 2026, in BMC Medicine, adds to this evidence, finding an association between cumulative anticholinergic drug burden and incident cardiovascular events. Whereas the research doesn’t prove a direct cause-and-effect relationship, it highlights the importance of carefully monitoring medication exposure, particularly in older adults.

What are Anticholinergic Drugs?

Anticholinergic drugs block the action of acetylcholine, a neurotransmitter that plays a vital role in many bodily functions, including heart rate regulation, digestion, and cognitive function. These medications are commonly prescribed for a wide range of conditions, including overactive bladder, chronic obstructive pulmonary disease (COPD), allergies, and Parkinson’s disease. Examples include certain antihistamines (like diphenhydramine), antidepressants, and medications for bladder control. Given that acetylcholine is involved in so many processes, blocking it can have a variety of effects, some of which can impact the cardiovascular system.

Study Details and Findings

The study, led by researchers at Karolinska Institutet in Sweden, analyzed data from over 11,898 patients. Researchers examined the association between cumulative exposure to anticholinergic medications and the risk of cardiovascular events, including heart attack, stroke, and irregular heartbeat. The findings indicated that individuals with a higher cumulative anticholinergic drug burden had a 18% lower risk of chronic kidney disease progression and a 21% lower risk of death compared to those who did not use these medications. The research was carried out within the Stockholm CREAtinine Measurements project, a collaboration between several research groups at Karolinska Institutet and Region Stockholm. Funding for the study came from the Swedish Research Council, the Center for Innovative Medicine Foundation, and other foundations.

Hong Xu, assistant professor at the Department of Neurobiology, Care Sciences and Society at Karolinska Institutet, emphasizes that the findings don’t necessarily mean these drugs should be avoided altogether. “Our results indicate that the cumulative drug burden can affect heart regulation, not only in the short term but also over the long term,” Xu explains. “This does not mean that the drugs should always be avoided, but that exposure should be monitored carefully.” More about Hong Xu’s research can be found on the Karolinska Institutet website.

Who is Affected?

The potential impact of anticholinergic drugs extends to a significant portion of the population, particularly older adults. As people age, they are more likely to experience multiple health conditions requiring medication, increasing the risk of polypharmacy – taking multiple medications simultaneously. This, in turn, raises the likelihood of accumulating a substantial anticholinergic drug burden. The study population had a mean age of 80 years, and 64% were women, suggesting that older women may be particularly vulnerable. However, it’s important to note that anyone taking medications with anticholinergic properties could be affected.

Understanding the Evidence: Observational Study Limitations

It’s crucial to understand that this study is observational, meaning researchers observed associations between medication use and health outcomes without directly manipulating variables. This type of study cannot definitively prove that anticholinergic drugs cause cardiovascular events. Other factors, such as underlying health conditions, lifestyle choices, and genetic predisposition, could also play a role. Researchers acknowledge that these confounding factors may influence the observed associations. The full study details are available on PubMed, including a discussion of potential biases and limitations.

Cholinesterase Inhibitors and Kidney Function

Interestingly, the study also explored the potential benefits of cholinesterase inhibitors (ChEIs), medications used to treat Alzheimer’s disease, on kidney function. Researchers found that ChEI use was associated with a lower risk of chronic kidney disease progression, potentially through activation of the cholinergic anti-inflammatory pathway. This finding suggests a complex interplay between cholinergic signaling, kidney health, and cardiovascular risk.

What Does This Mean for Patients?

This research doesn’t warrant immediate changes to medication regimens. Patients should not stop taking prescribed medications without consulting their healthcare provider. However, it does underscore the importance of open communication with doctors about all medications being taken, including over-the-counter drugs and supplements. A comprehensive medication review can support identify potential anticholinergic burden and explore alternative treatment options when appropriate.

It’s also important to remember that the risk associated with anticholinergic drugs is likely dose-dependent and cumulative. Higher doses and longer durations of use may pose a greater risk. Individuals experiencing symptoms such as dizziness, confusion, dry mouth, or blurred vision while taking these medications should promptly consult their doctor.

The Role of Public Health Surveillance

Ongoing surveillance of medication safety is crucial for identifying and addressing potential risks. Pharmacovigilance programs, such as those run by the Food and Drug Administration (FDA) in the United States and the European Medicines Agency (EMA) in Europe, continuously monitor the safety of medications and issue alerts when necessary. These programs rely on reports from healthcare professionals and patients to detect adverse drug events. The FDA website provides information on medication safety alerts and recalls.

What Comes Next: Further Research and Guidance Updates

Further research is needed to confirm these findings and to better understand the mechanisms by which anticholinergic drugs may affect cardiovascular health. Randomized controlled trials, which are considered the gold standard for establishing cause-and-effect relationships, would be necessary to definitively determine whether reducing anticholinergic burden can lower cardiovascular risk. Researchers are also exploring potential biomarkers that could identify individuals who are particularly susceptible to the adverse effects of these medications. As new evidence emerges, public health guidelines and clinical recommendations may be updated to reflect the latest understanding of anticholinergic drug safety.