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Time until incident dementia among Medicare beneficiaries using centrally acting or non‐centrally acting ACE inhibitors
Author(s) -
Hebert Paul L.,
McBean Alexander Marshall,
O'Connor Heidi,
Frank Barbara,
Good Charles,
Maciejewski Matthew L.
Publication year - 2013
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.3449
Subject(s) - medicine , observational study , dementia , medical prescription , pharmacoepidemiology , cohort study , incidence (geometry) , cohort , propensity score matching , medicare part d , retrospective cohort study , disease , emergency medicine , prescription drug , pharmacology , physics , optics
Background Centrally active (CA) angiotensin‐converting enzyme inhibitors (ACEIs) are able to cross the blood–brain barrier. Small observational studies and mouse models suggest that use of CA versus non‐CA ACEIs is associated with a reduced incidence of Alzheimer's disease and related dementias (ADRD). Objective The aim of this research was to assess the effect of CA versus non‐CA ACEI use on incident ADRD. Design This is a retrospective cohort study with a non‐equivalent control group. Setting and patients This study used a national random sample of Medicare beneficiaries enrolled in Part D with an ACEI prescription. A prevalent ACEI user cohort included beneficiaries ( n = 107 179) with an ACEI prescription prior to 30 April 2007; beneficiaries without an ACEI prescription before this date were defined as incident ACEI users ( n = 9840). Measurements The main outcome was time until first diagnosis of ADRD in Medicare claims. Results The unadjusted, propensity‐matched and instrumental variable analyses of both the prevalent and incident ACEI user cohorts consistently showed similar time until incident ADRD in those taking CA ACEIs compared with those who took non‐CA ACEIs. Limitations The limitations of this study include the use of observational data, relatively short follow‐up time and claims‐based measure of cognitive decline. Conclusions In this analysis of Medicare beneficiaries who were prevalent or incident users of ACEIs in 2007–2009, the use of CA ACEIs was unrelated to cognitive decline within 3 years of index prescription. Continued follow‐up of these patients and more sensitive measures of cognitive decline are necessary to determine whether a cognitive benefit of CA ACEIs is realized in the long term. Copyright © 2013 John Wiley & Sons, Ltd.