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Dewan P, Shen L, Pedro Ferreira J, Jhund PS, Anand IS, Chandra A, Chiang LM, Claggett B, Desai AS, Gong J, Lam CSP, Lefkowitz MP, Maggioni AP, Martinez F, Packer M, Redfield MM, Rouleau JL, van Veldhuisen DJ, Zannad F, Zile MR, Solomon SD, McMurray JJV. Effect of Sacubitril/Valsartan on Cognitive Function in Patients With Heart Failure With Preserved Ejection Fraction: A Prespecified Analysis of PARAGON-HF. Circulation 2024; 150:272-282. [PMID: 38841854 DOI: 10.1161/circulationaha.124.068774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND A hypothetical concern has been raised that sacubitril/valsartan might cause cognitive impairment because neprilysin is one of several enzymes degrading amyloid-β peptides in the brain, some of which are neurotoxic and linked to Alzheimer-type dementia. To address this, we examined the effect of sacubitril/valsartan compared with valsartan on cognitive function in patients with heart failure with preserved ejection fraction in a prespecified substudy of PARAGON-HF (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in Heart Failure With Preserved Ejection Fraction). METHODS In PARAGON-HF, serial assessment of cognitive function was conducted in a subset of patients with the Mini-Mental State Examination (MMSE; score range, 0-30, with lower scores reflecting worse cognitive function). The prespecified primary analysis of this substudy was the change from baseline in MMSE score at 96 weeks. Other post hoc analyses included cognitive decline (fall in MMSE score of ≥3 points), cognitive impairment (MMSE score <24), or the occurrence of dementia-related adverse events. RESULTS Among 2895 patients included in the MMSE substudy with baseline MMSE score measured, 1453 patients were assigned to sacubitril/valsartan and 1442 to valsartan. Their mean age was 73 years, and the median follow-up was 32 months. The mean±SD MMSE score at randomization was 27.4±3.0 in the sacubitril/valsartan group, with 10% having an MMSE score <24; the corresponding numbers were nearly identical in the valsartan group. The mean change from baseline to 96 weeks in the sacubitril/valsartan group was -0.05 (SE, 0.07); the corresponding change in the valsartan group was -0.04 (0.07). The mean between-treatment difference at week 96 was -0.01 (95% CI, -0.20 to 0.19; P=0.95). Analyses of a ≥3-point decline in MMSE, decrease to a score <24, dementia-related adverse events, and combinations of these showed no difference between sacubitril/valsartan and valsartan. No difference was found in the subgroup of patients tested for apolipoprotein E ε4 allele genotype. CONCLUSIONS Patients with heart failure with preserved ejection fraction in PARAGON-HF had relatively low baseline MMSE scores. Cognitive change, measured by MMSE, did not differ between treatment with sacubitril/valsartan and treatment with valsartan in patients with heart failure with preserved ejection fraction. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.
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Affiliation(s)
- Pooja Dewan
- BHF Cardiovascular Research Centre, University of Glasgow, UK (P.D., L.S., P.S.J., J.J.V.M.)
| | - Li Shen
- BHF Cardiovascular Research Centre, University of Glasgow, UK (P.D., L.S., P.S.J., J.J.V.M.)
- School of Clinical Medicine, Hangzhou Normal University, China (L.S.)
| | - João Pedro Ferreira
- Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (J.P.F., F.Z.)
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal (J.P.F.)
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, UK (P.D., L.S., P.S.J., J.J.V.M.)
| | - Inder S Anand
- VA Medical Center, University of Minnesota, Minneapolis (I.S.A.)
| | - Alvin Chandra
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.C.)
| | - Lu-May Chiang
- Novartis Pharmaceuticals, East Hanover, NJ (L.-M.C., J.G., M.P.L.)
| | - Brian Claggett
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (B.C., A.S.D., S.D.S.)
| | - Akshay S Desai
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (B.C., A.S.D., S.D.S.)
| | - Jianjian Gong
- Novartis Pharmaceuticals, East Hanover, NJ (L.-M.C., J.G., M.P.L.)
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.)
| | | | - Aldo P Maggioni
- National Association of Hospital Cardiologists Research Centre, Florence, Italy (A.P.M.)
| | | | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Centre, Dallas, TX (M.P.)
| | | | - Jean L Rouleau
- Institut de Cardiologie de Montreal, Universite de Montreal, Quebec, Canada (J.L.R.)
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, the Netherlands (D.J.v.V.)
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 1433 and Inserm U1116, CHRU Nancy, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), France (J.P.F., F.Z.)
| | - Michael R Zile
- Medical University of South Carolina, Charleston (M.R.Z.)
- Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z.)
| | - Scott D Solomon
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (B.C., A.S.D., S.D.S.)
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, UK (P.D., L.S., P.S.J., J.J.V.M.)
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Hill E, Cunningham T. Modelling Alzheimer's disease in a dish: dissecting amyloid-β metabolism in human neurons. Neuronal Signal 2024; 8:NS20230020. [PMID: 38222463 PMCID: PMC10781659 DOI: 10.1042/ns20230020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024] Open
Abstract
This scientific commentary refers to 'Inhibition of insulin-degrading enzyme in human neurons promotes amyloid-β deposition' by Rowland et al. (https://doi.org/10.1042/NS20230016). Insulin-degrading enzyme (IDE) and neprilysin (NEP) have been proposed as two Aβ-degrading enzymes supported by human genetics and in vivo data. Rowland et al. provide complementary evidence of a key role for IDE in Aβ metabolism in human-induced pluripotent stem cell (iPSC)-derived cortical neurons.
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Affiliation(s)
- Elizabeth Hill
- MRC Prion Unit at UCL, Institute of Prion Diseases, Courtauld Building, London W1W 7FF, U.K
| | - Thomas J. Cunningham
- MRC Prion Unit at UCL, Institute of Prion Diseases, Courtauld Building, London W1W 7FF, U.K
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