TY - JOUR
T1 - Sacubitril/valsartan and the risk of incident dementia in heart failure
T2 - a nationwide propensity-matched cohort study
AU - Lee, Hyun Jung
AU - Kim, Hyung Kwan
AU - Kim, Bong Seong
AU - Han, Kyung Do
AU - Kwak, Soongu
AU - Park, Chan Soon
AU - Rhee, Tae Min
AU - Park, Jun Bean
AU - Lee, Heesun
AU - Kim, Yong Jin
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2023.
PY - 2024/6
Y1 - 2024/6
N2 - Background: Sacubitril acts to inhibit neprilysin and as neprilysin is involved in amyloid-beta degradation in the central nervous system, and there is concern that sacubitril/valsartan may increase the risk of dementia. We aimed to compare the risk of incident dementia associated with sacubitril/valsartan and angiotensin II receptor blockers (ARBs). Methods: Patients with heart failure with reduced ejection fraction treated with either sacubitril/valsartan or ARB, identified from the Korean National Health Insurance Service database, were matched in a 1:2 ratio using propensity scores (6789 on sacubitril/valsartan and 13,578 on ARBs) and followed up for incident dementia. Results: During a mean follow-up of 2.5 years, 526 (2.6%) patients were newly diagnosed with dementia: Alzheimer dementia in 282, vascular dementia in 8, and other dementia in 236. There was no significant difference in the risk of overall dementia (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.70–1.01), Alzheimer dementia (HR 0.85, 95% CI 0.67–1.10), vascular dementia (HR 0.98, 95% CI 0.23–4.11), and all other dementias (HR 0.81, 95% CI 0.62–1.07) between sacubitril/valsartan users and ARB users. These results were consistent regardless of initial sacubitril/valsartan dose and subgroups including old age, previous mild cognitive impairment, previous stroke, and concomitant antiplatelet or anticoagulation. Sensitivity analysis with a 1-year lag period for dementia assessment confirmed the main analysis. Meanwhile, risk of incident stroke was lower in sacubitril/valsartan users compared to ARBs users. Conclusions: In a nationwide propensity-matched cohort of patients with heart failure, sacubitril/valsartan was not associated with an increased risk of incident dementia compared to ARBs. Graphic abstract: Sacubitril/valsartan and the risk of incident dementia in heart failure. ARB, angiotensin II receptor blocker; ARNI, angiotensin receptor neprilysin inhibitor. (Figure presented.)
AB - Background: Sacubitril acts to inhibit neprilysin and as neprilysin is involved in amyloid-beta degradation in the central nervous system, and there is concern that sacubitril/valsartan may increase the risk of dementia. We aimed to compare the risk of incident dementia associated with sacubitril/valsartan and angiotensin II receptor blockers (ARBs). Methods: Patients with heart failure with reduced ejection fraction treated with either sacubitril/valsartan or ARB, identified from the Korean National Health Insurance Service database, were matched in a 1:2 ratio using propensity scores (6789 on sacubitril/valsartan and 13,578 on ARBs) and followed up for incident dementia. Results: During a mean follow-up of 2.5 years, 526 (2.6%) patients were newly diagnosed with dementia: Alzheimer dementia in 282, vascular dementia in 8, and other dementia in 236. There was no significant difference in the risk of overall dementia (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.70–1.01), Alzheimer dementia (HR 0.85, 95% CI 0.67–1.10), vascular dementia (HR 0.98, 95% CI 0.23–4.11), and all other dementias (HR 0.81, 95% CI 0.62–1.07) between sacubitril/valsartan users and ARB users. These results were consistent regardless of initial sacubitril/valsartan dose and subgroups including old age, previous mild cognitive impairment, previous stroke, and concomitant antiplatelet or anticoagulation. Sensitivity analysis with a 1-year lag period for dementia assessment confirmed the main analysis. Meanwhile, risk of incident stroke was lower in sacubitril/valsartan users compared to ARBs users. Conclusions: In a nationwide propensity-matched cohort of patients with heart failure, sacubitril/valsartan was not associated with an increased risk of incident dementia compared to ARBs. Graphic abstract: Sacubitril/valsartan and the risk of incident dementia in heart failure. ARB, angiotensin II receptor blocker; ARNI, angiotensin receptor neprilysin inhibitor. (Figure presented.)
KW - Adverse drug event
KW - Dementia
KW - Heart failure
KW - Neprilysin
UR - http://www.scopus.com/inward/record.url?scp=85175328939&partnerID=8YFLogxK
U2 - 10.1007/s00392-023-02322-0
DO - 10.1007/s00392-023-02322-0
M3 - Article
C2 - 37906294
AN - SCOPUS:85175328939
SN - 1861-0684
VL - 113
SP - 875
EP - 883
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
IS - 6
ER -