Evidence map›Paper›PMID 25430550›Full record

Observational studyAge and ageing2015

Total anticholinergic burden and risk of mortality and cardiovascular disease over 10 years in 21,636 middle-aged and older men and women of EPIC-Norfolk prospective population study.

Phyo Kyaw Myint, Chris Fox, Chun Shing Kwok, Robert N Luben, Nicholas J Wareham, Kay-Tee Khaw

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Age and ageing, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
56citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

56 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Trial
  6. Article
  7. Effect of anticholinergic burden on cardiac functions in older patients.Zeitschrift fur Gerontologie und Geriatrie · 2026
    Article
  8. Mental health and kidney disease.Nature reviews. Nephrology · 2026
    Review
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Phyo Kyaw MyintSchool of Medicine and Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, UK Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire CB2 0QQ, UK.
Chris FoxSchool of Medicine, University of East Anglia, Norwich, Norfolk NR47TJ, UK.
Chun Shing KwokInstitute of Cardiovascular Sciences, University of Manchester, Manchester, Lancashire, M13 9WL, UK.
Robert N LubenClinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Addenbrooke's Hospital, Cambridge, Cambridgeshire CB2 0QQ, UK.
Nicholas J WarehamMRC Epidemiology Unit, Cambridge, Cambridgeshire, UK.
Kay-Tee KhawClinical Gerontology Unit, Department of Public Health and Primary Care, Clinical Gerontology Unit, University of Cambridge, Cambridge CB2 2QQ, UK School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.

Funding

Cancer Research UK 8257Medical Research Council G0401527Medical Research Council G0500300Medical Research Council G0800603Medical Research Council G1000143Medical Research Council MC_U106179471Medical Research Council MC_UU_12015/1
6 · The paper itself

Abstract

backgroundStudies have raised concerns that medications with anticholinergic property have potential adverse effects on health outcomes.

objectivesThe objective of this study is to examine the prospective relationships between total anticholinergic burden (ACB) from medications and mortality, and cardiovascular disease (CVD) in a general population.

designObservational study.

settingCommunity cohort. SUBJECTS: We examined data collected from 21,636 men and women without cancer at the baseline who participated in a baseline survey 1993-97 in the European Prospective Investigation into Cancer (EPIC)-Norfolk. They were followed until 2009/11.

methodsWe performed Cox-proportional hazards models to determine the associations between total ACB and the subsequent risk of all-cause mortality and incident CVD during the follow-up.

resultsThere were a total of 4,342 people died and 7,328 had an incident CVD during the study follow-up (total person years=322,321 years for mortality and 244,119 years for CVD event). Compared with people with no anticholinergic burden (ACB=0), people with total ACB≥3 from medications had hazards ratios of 1.83 (1.53, 2.20) and 2.17 (1.87, 2.52) for mortality and CVD incidence outcomes, respectively, after adjusting for potential confounders. Repeating the analyses after excluding people with prevalent illnesses, and events occurring within the first 2 years of follow-up, only slightly attenuated the results.

conclusionThere appear to be a class effect as well as dose-response relationship between the ACB and both outcomes. Future research should focus on understanding the relationship between ACB and mortality, and cardiovascular disease and possibly minimising ACB load where feasible.

Indexed as

AdultAgedAge DistributionAge FactorsCardiovascular DiseasesCause of DeathCholinergic AntagonistsDose-Response Relationship, DrugEnglandFemaleHealth Care SurveysHumansIncidenceMaleMiddle AgedMultivariate AnalysisCholinergic Antagonistsanticholinergic burdencardiovascular diseasesepidemiologymortalityolder people

Identifiers

PMID25430550
PMCPMC6287704

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.