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Objective To evaluate the association between recently raised anticholinergic burden and risk of acute cardiovascular events in older adults. Design Case-case-time-control study (ie, incorporating a case crossover design and a control crossover design consisting of future cases). Setting Taiwan’s National Health Insurance Research Database. Participants 317 446 adults aged ≥65 who were admitted to hospital because of an incident acute cardiovascular event between 2011 and 2018. Acute cardiovascular events included myocardial infarction, strokes, arrhythmias, conduction disorders, and cardiovascular death. Main outcome measures The anticholinergic burden was measured for each participant by adding up the anticholinergic scores for individual drugs using the Anticholinergic Cognitive Burden Scale. Scores were classified into three levels (0 points, 1-2 points, and ≥3 points). For each participant, anticholinergic burden levels during hazard periods (day −1 to −30 before t

National cheng kung universityTainan municipalityKao hsiungHualian xianT ai peiDaniel hsiangEdward chia cheng laiShih chieh shaoWei ching huangAvery shueiSwu jane linTaiwan ministry of healthWorld health organizationSetting taiwan national health insurance research databaseNational scienceNational health research institutes of taiwan