Cardiovascular Effect of Drugs Used to Treat Alzheimer’s Disease

This review examines the cardiovascular effects of the mainstay drugs used to treat Alzheimer's disease (AD), namely cholinesterase inhibitors (ChEIs) and memantine. ChEIs represent the current first-line treatment for AD. Memantine is typically reserved for moderate to severe AD. Conventionally, ChEIs are thought to increase vagal tone, resulting in an increased risk of cardiac side effects such as bradycardia. However, emerging evidence suggests that ChEIs may offer a protective role on overall cardiovascular mortality in patients with dementia. Similarly, memantine, which is an N-methyl-D-aspartate receptor antagonist, has demonstrated cardioprotective properties in animal studies, raising the question of its clinical applications. Recently, aducanumab and lecanemab, antiamyloid-β monoclonal antibodies that aim to slow the progression of disease, have been Food and Drug Administration-approved for the treatment of AD. This review explores the current evidence regarding potential cardiovascular risks and protective effects of ChEIs and memantine in the treatment of AD, as well as the cardiovascular effects of aducanumab and lecanemab.