Cardiovascular Effects of Acetylcholinesterase Inhibitors

Acetylcholineasterase (AChE) inhibitors constitute a large and chemically diverse group of compounds that inhibit the enazyme AChE irreversibly (organophosphatesOrganophosphates, such as nerve agentsNerve agents and insecticidesInsecticides), pseudo-irreversibly (carbamatesCarbamates, such as physostigminePhysostigmine and pyridostigminePyridostigmine and rivastigmineRivastigmine) and reversibly (various molecules, such as ambenoniumAmbenonium, donepezilDonepezil, galantamineGalantamine). They are used as drugs against myasthenia gravis and Alzheimer’s diseaseAlzheimer’s disease, but also as chemical warfare agentsChemical warfare agents and insecticidesInsecticides. Their favourable therapeutic effects aside (potential use in myocardial infarctionMyocardial infarction, heart failureHeart failure, arrhythmiaArrhythmia, diseases of blood vessels), they produce a spectrum of cardiovascular adverse effects, in humans and experimental animals alike. Some of these toxic effects result from the central and peripheral AChE inhibition, while the others are non-cholinergic and have different mechanisms involving other enzymes, ion channels and reactive oxygen speciesReactive oxygen species and manifest themselves as direct cardiac or direct vascular toxicityVascular toxicity.