Summary of Methods and Results
The study by Li et al. involved examining the records of approximately 7.3 million people in the database of the Veterans Health System over a period of 5 years. Patients aged 65 years or older with cardiovascular disease were studied. Three cohorts were examined, namely those taking angiotensin receptor blockers, those taking the ACE inhibitor lisinopril, and a comparative group taking cardiovascular drugs other than either these two classes, or statins. The time to the onset of incident AD or dementia over a 4-year period for those who were initially free of these conditions was determined. Outcome measures for the progression of AD and dementia were defined as admission to a nursing home or death. A total of 819,491 patients with AD and 799,069 with dementia were studied. The characteristics of these groups and the therapeutic cohorts were similar, having a mean age of 74 years and with 98% being men. There were significant differences between therapeutic groups with regard to comorbid conditions, with cardiovascular disease and stroke being more prevalent in the cardiovascular comparator group, and diabetes being more prevalent in the angiotensin receptor blocker and lisinopril groups, as could be expected. There were no differences in blood pressure between groups.
Cox proportional hazard models were adjusted for age, diabetes, stroke and cardiovascular disease. Compared with the cardiovascular comparator group, the hazard ratio for incident dementia in the angiotensin receptor blocker group was 0.76 (95% CI: 0.69–0.84), and 0.81 (95% CI: 0.73–0.90) compared with the lisinopril group. For those with AD, the use of angiotensin receptor blockers was associated with a significantly lower risk of admission to a nursing home (HR: 0.51; 95% CI: 0.36–0.72) and death (HR: 0.83; 95% CI: 0.71–0.97) compared with the cardiovascular comparator group. There was a dose–response effect of angiotensin receptor blockers on the incidence of dementia. The combination of angiotensin receptor blockers with ACE inhibitors exhibited an additive effect, both on incident AD and dementia and on nursing home admission.
Aging health. 2010;6(3):85-287. © 2010
Future Medicine Ltd.
Cite this: Angiotensin Receptor Blockers: Do They Protect Against Dementia and Alzheimer’s Disease in the Elderly? - Medscape - Jun 01, 2010.