[메디컬투데이TV] There is a clear link between heart disease and dementia… Can anticoagulants reduce the risk of dementia?

[메디컬투데이=최재백 기자] Research has shown a clear link between cardiovascular disease and an increased risk of cognitive impairment and depression.

Research results that show a clear correlation between cardiovascular diseases such as heart failure, atrial fibrillation, and coronary artery disease and an increased risk of mental illness and depression have been published in the academic journal ‘Molecular Psychiatry’.

Stroke and cognitive decline, which are important factors in brain health, are chronic, disabling diseases that have a significant impact on individuals and society. In particular, depression is often considered a progressive disease that cannot be cured, but evidence suggests that cognitive function can be preserved by adopting a healthy lifestyle and management of vascular risk factors.

According to a report from the American Heart Association (AHA), heart failure contributes to about 50% of cognitive problems, including memory and language impairment. In addition, atrial fibrillation (AFib), the most common arrhythmia, is associated with a 39% higher risk of developing cognitive impairment, coronary artery disease increases the risk of dementia by 27%, and heart attack survivors are at risk of cognitive decline. It has been reported to increase by up to 50%.

At the same time, research has been done in the past showing that when ‘active oral anticoagulant (DOAC)’ treatment is given to patients with atrial fibrillation, the risk of developing dementia is reduced by 12% compared to when ‘warfarin’, a traditional method. anticoagulant, used.

In addition, a research team recently reported that patients treated with heparin showed signs of Alzheimer’s two years later than the normal course of Alzheimer’s disease, and argued that heparin can help not only with cardiovascular disease but also mental health.

The development of Alzheimer’s disease is associated with apolipoprotein E (ApoE) protein. ApoE interacts with ‘heparan sulfate proteoglycans (HSPGs)’ molecules on the cell surface.

Among the different types of ApoE protein, the ApoE4 gene mutation is the genetic predisposition that shows the strongest correlation with the risk of developing Alzheimer’s disease, and HSPGs are also involved in accumulates tau protein, another key factor in Alzheimer’s brain damage.

Proteins that bind to HSPGs can accumulate in the brain long before symptoms appear, and genes associated with heparan sulfate production have also been identified as risk factors for Alzheimer’s disease.

Among these, attention is being paid to whether heparin, a type of heparan sulfate that has been used to prevent blood clots since the 1930s, can delay the progression of Alzheimer’s disease by blocking interactions ApoE-HSPG.

The research team analyzed medical records from Mount Sinai Health System (MSHS) and Columbia University Medical Center (CUMC) and compared patients who took heparin and those who did not.

Among the total of 15,183 MSHS cohort patients, 24.7% took heparin, and among the 6,207 CUMC patients, 51.5% received heparin treatment.

Although all study participants were eventually diagnosed with Alzheimer’s disease, it was found that patients who received heparin treatment were diagnosed with Alzheimer’s disease, on average, about a year later than patients who did not. heparin treatment.

The research team hypothesized that heparin, an anticoagulant, affects the way the APOE protein binds to heparin-like molecules, delaying the clinical diagnosis of Alzheimer’s disease depression by about a year.

They assessed that the results of this study will not change the current use of heparin or the treatment and prevention of Alzheimer’s disease, but it will be good data for developing new treatments for patients with Alzheimer’s disease, including those with the APOE4 gene. .

They hoped that if they could prevent the APOE protein from binding to HSPG, they could treat and even prevent Alzheimer’s disease.

Experts warn that heparin should not be used yet to prevent Alzheimer’s. They said that if possible, patients should be monitored in hospitals to see if the use of heparin reduces the risk of stroke dementia or vascular dementia, or multi-infarct dementia.

Next, they predicted that electronic medical record data should be used to evaluate treatments that could be used to treat and prevent Alzheimer’s disease beyond their original development intent. .

At the same time, contrary to expectations that heparin can protect brain health, heparin usually does not reach the brain easily and is used only in the short term, so it is not clear whether it effective as a brain health protective drug, so more research is needed.

Medical Today Video Editing Team ([email protected])

[저작권자ⓒ 메디컬투데이. 무단전재-재배포 금지]