DOI: 10.1161/jaha.125.048108 ISSN: 2047-9980

Amyloid‐Related Imaging Abnormalities Summit Special Proceedings: Cardiovascular and Stroke Considerations for β‐Amyloid Immunotherapy in Alzheimer Disease

Steven M. Greenberg, Costantino Iadecola, Sherry H.‐Y. Chou, Petrice M. Cogswell, Mitchell S. V. Elkind, William J. Hicks, Caitlin Le, Deborah A. Levine, Richard Lipton, Lauren Massimo, Stephanie M. Mohl, Sudha Seshadri, Heather M. Snyder, Kristine Yaffe, Kori S. Zachrison, Robert Adams, Marc Agronin, Alireza Atri, Mary Ann Bauman, James L. Bernat, Alessandro Biffi, Sonja Blum, Thierry Bussiere, Tara C. Carlisle, Maria C. Carrillo, Gloria Chiang, Kenrick Cato, Alexander Chaitoff, Suzanne Bakken, Matthew W. Schelke, Salvador Cruz‐Flores, Janice Y. Chyou, Colin Derdeyn, Amar Dhand, David A. Evans, Cameron Gettel, Larry B. Goldstein, Joshua Grill, Makoto Ishii, Ambar Kulshrestha, Christine Lam, Ronald M. Lazar, Hanlin Li, Tracy Madsen, Alejandro A. Rabinstein, Vijay K. Ramanan, Louise McCullough, José G. Merino, Karen Orjuela, Michael Guo, Steve Messe, Maggie Tubiello, Christian T. Ruff, Stephen R. Saklad, Magdy Selim, Sharon J. Sha, Sachin J. Shah, Kevin Sheth, Brian Stamm, Marion Buckwalter, Irina Skylar‐Scott, Helen Lavretsky, Jeffrey Saver, Gil D. Rabinovici, Lawren VandeVrede, Arindam Rano Chatterjee, Manu S. Goyal, David C. Weisman, Richard G. Wunderink
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Background

New antiamyloid therapies (AAT) for treating patients with early Alzheimer disease (AD) have become available in the past 3 years. Although AAT can be beneficial in slowing progression of AD, they also come with potentially serious side effects, particularly for patients requiring anticoagulation or thrombolysis for cardiovascular conditions. Given that most patients with AD are older and likely to have cardiovascular risk factors, there is urgent need for additional guidance for clinicians about potential risks and benefits associated with AAT for patients with cardiovascular comorbidities, best practices for management of these patients, and special considerations with respect to emergency evaluation and treatment of patients on AAT who develop acute neurological symptoms.

Methods

The American Heart Association convened 75 multidisciplinary experts for the Amyloid‐Related Imaging Abnormalities Summit: Cardiovascular and Stroke Considerations for β‐Amyloid Immunotherapy in AD in July 2025. These experts were divided into 8 work groups to evaluate the current evidence related to AAT usage in patients with cardiovascular risk factors and conditions and develop consensus‐based guidance for clinicians.

Results

This statement outlines the outcomes of the Summit, including considerations for prescribers, primary care professionals, emergency personnel, and health care system stakeholders. These considerations are intended to improve identification of patients as appropriate candidates for AAT, management of patients with co‐occurring AD and cardiovascular conditions, and their emergency evaluation and treatment. The statement also includes guidance for shared decision‐making, implementation of system changes for improving dementia care, and recommendations for future research and data collection to add to the body of evidence for treating patients with concomitant AD and cardiovascular conditions.

Conclusions

Building on lessons learned from the establishment of stroke systems of care, the consensus‐based considerations outlined in this document can serve as a foundation for AD systems of care aimed at ensuring optimal use of these ground‐breaking therapies.

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