Long-Term Overtreatment With Anticlotting and Antiplatelet Drugs May Increase Risk of Dementia
Long-term overtreatment with the anticlotting drug warfarin, combined with antiplatelet therapy based on aspirin or clopidogrel to prevent stroke, may increase the risk of dementia in patients with atrial fibrillation, according to researchers.
“The dual drug regimen is often used to prevent strokes in people with coronary artery disease or peripheral vascular disease, but we have to consider that long-term exposure to anticlotting drugs such as warfarin, if not well controlled, can significantly increase bleeding risk,” said T. Jared Bunch, MD, Director of Electrophysiology at the Intermountain Heart Institute in Murray, Utah, and lead author of the study. “This [increased risk] may result in microbleeds in the brain that don’t cause symptoms right away, but accumulate over time, [thus] raising the risk of dementia.”
The researchers studied 1,031 patients with no previous history of stroke or dementia for as long as 10 years while they were taking the drug combination. Patients who had abnormally slow clotting times were considered to be receiving too much medication. After adjusting for traditional stroke and bleeding risk factors, the investigators found that patients who had abnormally slow blood clotting times, as indicated by an International Normalized Ratio (INR) measurement greater than 3, on 25% or more of their monitoring tests were more than twice as likely to be diagnosed with dementia than were patients whose tests showed overtreatment less than 10% of the time. The increase is higher than that seen in a previous study of warfarin alone.
The investigators previously found that patients with atrial fibrillation who received warfarin were more likely to develop dementia if laboratory measurements indicated that their clotting times were frequently too slow (thus increasing the risk of bleeding) or too fast (thus increasing the risk of blood clots). From those results, the researchers concluded that brain injury from small bleeds and clots was important in the development of dementia in patients with atrial fibrillation.
“Even at skilled centers, it’s very common to have INR outside the ideal range up to 40% of the time, and, over the years, there may be an accumulative negative impact on cognitive ability,” said Dr. Bunch. A patient who takes warfarin and an antiplatelet drug such as aspirin or clopidigrel should check with his or her doctor to make sure that he or she needs one or both of the long-term antiplatelet medications, he added.
“If your INRs are consistently too high, for stroke prevention, your doctor may want to consider switching you to one of the newer anticlotting drugs that is easier to regulate or [to] a device placed into the heart that prevents clots from forming or exiting the area in the heart chamber where most clots develop in people with atrial fibrillation,” said Dr. Bunch. Most patients in the study were Caucasian, and the researchers are not sure whether the results apply to other ethnic groups.
Trans Fat Consumption Is Linked to Diminished Memory in Working-Aged Adults
High trans fat consumption is linked to worse memory among working-age men, investigators reported.
In a recent study of approximately 1,000 healthy men, those who consumed the most trans fats showed notably worse performance on a word memory test. The strength of the association remained after the investigators took factors such as age, education, ethnicity, and depression into consideration.
“Trans fats were most strongly linked to worse memory in young and middle-aged men during their working and career-building years,” said Beatrice A. Golomb, MD, PhD, Professor of Medicine at the University of California, San Diego, and lead author of the study. “From a health standpoint, trans fat consumption has been linked to higher body weight, more aggression, and heart disease. As I tell patients, while trans fats increase the shelf life of foods, they reduce the shelf life of people.”
Dr. Golomb and her colleagues studied adults who had not been diagnosed with heart disease, including men age 20 or older and postmenopausal women. Participants completed a dietary questionnaire from which the researchers estimated participants’ trans fat consumption. To assess memory, the researchers presented participants with a series of 104 cards showing words. Subjects were asked to state whether each word was new or duplicated from a previous card.
The researchers found that among men younger than 45, people who ate more trans fats had notably worse performance on the word memory test. The strength of the association remained after factors such as age, education, ethnicity, and depression were taken into consideration.