A population-based, retrospective cohort study of approximately half a million residents of Stockholm (aged ≥ 45 as of January 2008 with no history of CVD) sought to investigate a possible association between use of anticholinergic medications and the risk of cardiovascular disease. The cohort was followed up over 14 years. Medications may be prescribed for their inherent anticholinergic effects, or may have anticholinergic effects over and above their primary mechanism of action (e.g. antihistamines and many antidepressants and neuroleptics).

Higher cumulative use of anticholinergics was associated with a higher incidence of cardiovascular events. Anticholinergic use in older adults has previously been associated with cognitive decline and increased risk of falls. Whilst association does not confirm causation, this study highlights another reason to be mindful of the use of anticholinergics in individuals as they age, especially considering additive anticholinergic adverse effects of various medication classes.

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