ARBs, ACE inhibitors, and Alzheimer’s
28 Janvier 2010
Boston, MA - A new study shows a significant reduction in the incidence of Alzheimer’s disease and dementia among subjects taking angiotensin-receptor blockers (ARBs), compared with those taking angiotensin-converting enzyme (ACE) inhibitors or other cardiovascular drugs .
Further, there appeared to be a reduction in rates of disease progression, indicated by the time to admission to a nursing home or death, among those taking ARBs, the authors note.
"We also saw that the
people who did the best appeared to be those who were taking ARBs together with ACE inhibitors," said senior author Dr Benjamin Wolozin (Boston University School of Medicine, MA).
"There, the data actually get very striking ; we saw a 55% lower incidence of Alzheimer’s [disease] or dementia, and a 70% decrease in nursing-home admissions," Wolozin added.
Their report was published online January 12 in the British Medical Journal.
ARBs selectively inhibit the AT1 receptor, and although slightly less effective at lowering blood pressure than ACE inhibitors, they have been shown in an increasing number of studies to be related to preservation of cognitive function through a mechanism independent of their antihypertensive action, the authors write.
In this study, Wolozin and colleagues used data from the US Veterans Affairs administrative database to look at time to incident Alzheimer’s disease or dementia over a four-year period in three prospective cohorts. Participants were predominantly male, 65 years and older, with a diagnosis of cardiovascular disease. Subjects in one group were taking an ARB, in a second group were taking the ACE inhibitor lisinopril, and in a third comparator group were taking other cardiovascular drugs but were not taking ARBs, ACE inhibitors, or statins.
After adjustment for age, diabetes, stroke, and cardiovascular disease, incident Alzheimer’s disease, and particularly incident dementia, were reduced in the ARB group, compared with both the ACE inhibitor and the comparator groups.
Risk for incident Alzheimer’s disease and dementia with ARBs vs ACE inhibitors (lisinopril) and other cardiovascular drugs (comparator)
Among those who already had Alzheimer’s disease, treatment with an ARB was associated with a significantly lower risk of admission to a nursing home or death over the follow-up period.
The investigators point out that stroke was consistently ranked the most important covariate in this dataset, suggesting the importance of vascular factors in the progression of cognitive loss. ARBs have also been shown to be effective in preventing vascular damage induced by the amyloid-beta that accumulates in this disease, they note.
1. Li NC, Lee A, Whitmer RA, et al. Use of angiotensin receptor blockers and risk of dementia in a predominantly male population : Prospective cohort analysis. BMJ. 2010 ; 340 :b5465.