Soodeh Jahangiri, Eliot Kazakov, Saipranusha Amancherla, Andreas P. Kalogeropoulos
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Eligible studies were randomized controlled trials (RCT) or cohort studies assessing cognitive function in adult HF patients.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Three cohort studies on ACEi/ARBs (<i>N</i> = 5080; 2 prospective, 1 retrospective) reported no significant impact on cognitive function to higher cognitive scores with ACEi/ARBs. Eight studies on sacubitril/valsartan (ARNI, <i>N</i> = 42,143; all observational studies or post-hoc analyses of RCT) found either no effect on cognitive function or reduced risk of new-onset dementia and improved cognitive outcomes with ARNI. 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引用次数: 0
摘要
背景：心力衰竭常与认知功能障碍共存，并加速认知功能衰退。然而，心衰药物对认知的影响受到的关注有限。本综述评估了目前推荐的心衰药物类别对认知影响的证据。方法：根据PRISMA指南，使用PubMed和EMBASE进行系统评价，使用与心衰、认知功能和指南推荐的心衰药物相关的关键词。符合条件的研究是评估成年心衰患者认知功能的随机对照试验（RCT）或队列研究。结果：3项ACEi/ARBs队列研究(N = 5080；2项前瞻性研究，1项回顾性研究)报道认知功能对ACEi/ arb的认知评分没有显著影响。8项关于苏比里尔/缬沙坦的研究(ARNI, N = 42,143；所有观察性研究或随机对照试验的事后分析都发现，ARNI对认知功能没有影响，也没有降低新发痴呆的风险，并改善了认知结果。受体阻滞剂(N = 40；1项随机对照试验)缺乏显著的认知影响；恩帕列净(SGLT2i, N = 162；1 .前瞻性)改善糖尿病和HF患者的认知能力并保留射血分数；地高辛(N = 1172；1例回顾性)与认知功能增强有关；他汀类药物(N = 112,357；2回顾性)，这表明在缺血性HF的病因上，与认知能力的显着影响无关。结论：指南推荐的HF药物类别似乎对认知功能没有中性影响，有些甚至可能提供认知益处。然而，研究的数量有限，而且大多是观察性的，因此无法得出确切的结论。为了更好地了解心衰药物对认知的影响，需要进一步的研究。
Impact of heart failure medications on cognitive function: A systematic review
Background
Heart failure (HF) often coexists with cognitive impairment and accelerates cognitive decline. However, the impact of HF medications on cognition has received limited attention. This review evaluates the evidence on the cognitive effects of currently recommended medication classes for HF.
Methods
Systematic review using PubMed and EMBASE following PRISMA guidelines, employing keywords related to HF, cognitive function and guideline-recommended HF medications. Eligible studies were randomized controlled trials (RCT) or cohort studies assessing cognitive function in adult HF patients.
Results
Three cohort studies on ACEi/ARBs (N = 5080; 2 prospective, 1 retrospective) reported no significant impact on cognitive function to higher cognitive scores with ACEi/ARBs. Eight studies on sacubitril/valsartan (ARNI, N = 42,143; all observational studies or post-hoc analyses of RCT) found either no effect on cognitive function or reduced risk of new-onset dementia and improved cognitive outcomes with ARNI. Beta-blockers (N = 40; 1 RCT) lacked significant cognitive effects; empagliflozin (SGLT2i, N = 162; 1 prospective) improved cognitive performance in patients with diabetes and HF with preserved ejection fraction; digoxin (N = 1172; 1 retrospective) was associated with enhanced cognitive function; and statins (N = 112,357; 2 retrospective), which are indicated in HF of ischemic aetiology, were not associated with a significant effect on cognition.
Conclusions
Guideline-recommended HF medication classes appear to have neutral effects on cognitive function, and some may even offer cognitive benefits. However, the limited number and mostly observational nature of studies prevent firm conclusions. Further research is necessary to better understand the cognitive impact of HF medications.
期刊介绍：
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