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European Heart Journal Advance Access published online on December 6, 2004
European Heart Journal, doi:10.1093/eurheartj/ehi058
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European Heart Journal © The European Society of Cardiology 2004; all rights reserved.

Clinical research

Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure

Giuseppe Zuccalà 1*, Graziano Onder 1, Emanuele Marzetti 1, Maria R. Lo Monaco 1, Matteo Cesari 2, Alberto Cocchi 1, Pierugo Carbonin 1, Roberto Bernabei 1, and for the GIFA Study Group

1 Catholic University, Department of Gerontology, Geriatrics, and Physiatrics, L.go F. Vito, I-00168 Rome, Italy
2 Sticht Center on Aging, Department of Internal Medicine, Wake Forest University, Winston Salem, NC, USA

* To whom correspondence should be addressed.
Giuseppe Zuccalà, E-mail: giuseppe_zuccala{at}rm.unicatt.it


  Abstract

Aims Cognitive dysfunction is a prevalent condition among patients with heart failure, and is independently associated with disability and mortality. Angiotensin-converting enzyme (ACE)-inhibitors might increase cerebral blood flow in subjects with heart failure. Our aim was to assess whether starting treatment with ACE-inhibitors might improve cognition in patients with heart failure.

Methods and results Analyses involved 12081 subjects, 1220 of whom had a verified diagnosis of heart failure, enrolled in a multi-centre pharmaco-epidemiology survey. None of these participants received ACE-inhibitors before hospitalization. Among participants with heart failure, cognitive performance improved in 30% of 446 participants who started ACE-inhibitors, but only in 22% of remaining patients (P = 0.001). Among participants without heart failure, cognition improved in 19% of those receiving ACE-inhibitors, and in 18% of untreated patients (P = 0.765). Use of ACE-inhibitors among patients with heart failure was associated with improving cognition (odds ratio = 1.57; 95% CI 1.18-2.08) also in the multivariable regression modelling, independently of baseline or discharge blood pressure levels. The probability of improving cognitive performance was higher for dosages above the median values, as compared with lower doses (odds ratios = 1.90 and 1.42; P for trend = 0.001), and increased with duration of treatment (odds ratios for the lower, middle, and upper tertiles = 1.25, 1.34, and 1.59; P for trend = 0.007).

Conclusion Treatment with ACE-inhibitors might selectively improve cognitive performance in patients with heart failure. However, up-titration of these agents might be required to yield the greatest benefit.

Keywords: Heart failure; Angiotensin-converting enzyme inhibitors; Vascular dementia; Epidemiology.
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