# Deprescribing Cardiovascular Medications among Persons with and without Alzheimer's Disease and Related Dementias in Long-Term Care

> **NIH NIH R01** · PALO ALTO VETERANS INSTIT FOR RESEARCH · 2024 · $727,688

## Abstract

PROJECT SUMMARY/ABSTRACT
The use of preventive cardiovascular medications among nursing home residents with Alzheimer's disease
and Alzheimer's disease related dementias (AD/ADRD) presents a clinical conundrum. On one hand, the
majority of nursing home residents with AD/ADRD have a history of cardiovascular disease, or are at high risk
of events. On the other hand, residents with AD/ADRD are at higher risk for medication-related adverse events
and have less opportunity to benefit from preventive medications such as aspirin and statins. This has led
some patients and their providers to consider deprescribing. Deprescribing is the process of stopping a
medication when it is no longer useful, or when the risks outweigh the benefits. Despite the thousands of
randomized controlled trials that have been conducted for starting cardiovascular medications, only a handful
have been conducted for deprescribing. The effects of deprescribing cardiovascular medications, and which
patients could benefit, is unknown. The goal of this renewal application is to provide novel, unparalleled
evidence on the effects of deprescribing cardioprotective medications in patients with and without AD/ADRD.
We will build upon our prior successful cohort of nursing home residents (nearly half of whom have AD/ADRD)
to conduct this research in approximately 150,000 residents aged 65 years and older in Veteran's Health
Administration (VA) nursing homes. The VA is the only feasible setting to execute this research because of the
ability to link inpatient and outpatient data with data from the nursing home. Moreover, unlike data from the
Centers from Medicaid/Medicare, the VA includes data on vital signs, laboratory measurements, and bar-coded
medication administrations. We will start with descriptive epidemiology regarding the frequency of
deprescribing as well as the common precipitating events and characteristics of residents whom are commonly
deprescribed cardiovascular medication. This will identify which drugs are the most important targets for further
research, and the populations in which there is clinical uncertainty. Traditional clinical trials are challenging in
residents with AD/ADRD due to their care complexity and often impaired decision-making capacity. Thus, we
will next implement target trial emulation of deprescribing cardiovascular medications; this is a method of
estimating trial effects using observational data. This approach applies a structured analytic process to address
common biases in observational research and leverages causal inference statistics to address confounding by
indication. We have successfully applied this approach to study the effect of changes in antihypertensives in
older residents with and without AD/ADRD. In this renewal application, we will study the effects of
deprescribing multiple cardioprotective medications, specifically, antiplatelets including aspirin, statins, and
anticoagulants in nursing home residents with and without AD/ADRD.

## Key facts

- **NIH application ID:** 10880164
- **Project number:** 2R01AG062568-02
- **Recipient organization:** PALO ALTO VETERANS INSTIT FOR RESEARCH
- **Principal Investigator:** Michelle Christina Odden
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $727,688
- **Award type:** 2
- **Project period:** 2019-05-15 → 2029-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10880164

## Citation

> US National Institutes of Health, RePORTER application 10880164, Deprescribing Cardiovascular Medications among Persons with and without Alzheimer's Disease and Related Dementias in Long-Term Care (2R01AG062568-02). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10880164. Licensed CC0.

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