BMC Med

Higher anticholinergic burden tied to greater cardiovascular risk

March 18, 2026

In a large population-based cohort study, higher cumulative anticholinergic drug burden was associated with a significantly increased risk of incident cardiovascular events. The study followed 508,273 adults aged ≥45 years without prior major cardiovascular disease for a median of 14 years, during which 118,266 cardiovascular events occurred. Using time-updated models, risk increased in a clear dose–response fashion: compared with no exposure, adjusted hazard ratios (HRs) were 1.16 for 1–89 defined daily doses (DDDs), 1.31 for 90–364 DDDs, and 1.71 for ≥365 DDDs annually. The strongest associations were seen for heart failure (HR, 2.70) and arrhythmias (HR, 2.17), with elevated risks also observed for myocardial infarction (HR, 1.46), cerebrovascular disease (HR, 1.32), venous thromboembolism (HR, 1.32), and arterial disease (HR, 1.48).

Clinical takeaway: Assess cumulative anticholinergic exposure—not just individual drugs—particularly in patients with cardiovascular risk, and consider lower-anticholinergic alternatives or deprescribing when appropriate.

Source:

Zhu N, et al. (2026, February 28). BMC Med. Anticholinergic drug burden and incident cardiovascular events: a population-based study. https://pubmed.ncbi.nlm.nih.gov/41761231/