Angiotensin converting enzyme serum activities: Relationship with Alzheimer's disease.

OBJECTIVE: To determine serum activities of angiotensin-converting enzyme (ACE) as a marker in diagnosis and determine the severity of Alzheimer's disease (AD), METHODS: We measured serum ACE activities in 59 moderate-severe AD, 19 mild AD, 45 amnestic mild cognitive impairment (aMCI) and 39 controls. RESULTS: We found that patients in moderate-severe AD stages showed significantly higher ACE in comparison to aMCI and controls (ANOVA, LSD post hoc test: p: 0.02 and p: 0.01, respectively). Logistic regression analysis showed that if ACE activities added 200 U/L, the superiority of AD risk was 1.18 times higher than before compared with the control group (OR 1.18, 95% CI 1.01-1.74; P=0.49). By means of multivariate linear regression analysis, we found that age (ß coefficient: 7.77; P: 0.01) was significantly associated with ACE activities. However, ACE activities were found to be significantly negatively associated with measures of orientation and immediate recall among the AD patients (r<0, P<0.05), whereas ACE activities were not associated with any MMSE scores among the non-AD groups (P > 0.05).uuuu CONCLUSIONS: ACE serum activity that correlates with age is likely to constitute a potential risk factor for the development of AD. ACE serum activity might be a useful biomarker for disease status with increasingly high ACE from mild stage to moderate-severe stage. Moreover, patients with aMCI could take ACE inhibitor (ACEI) to decrease the incidence of AD, and patients with AD could take ACEI to retard cognitive decline in early AD.

The association of renin-angiotensin system blockade use with the risks of cognitive impairment of aging and Alzheimer's disease: A meta-analysis.

A quantitative meta-analysis was performed to evaluate the association of renin-angiotensin system blockade (RASB) use with the incidence of cognitive impairment of aging and Alzheimer's disease (AD). Pubmed, Embase, and Cochrane Library databases were searched up to October 2015. Ten studies that assessed the relationship between RASB use and the incidence of cognitive impairment of aging or AD were included. When randomized trials and observational studies were combined, the use of RASB was significantly associated with a reduced risk of AD (risk ratio [RR], 0.80; 95% confidence interval [CI] 0.68-0.92) and cognitive impairment of aging (RR, 0.65; 95% CI 0.35-0.94) compared no use of RASB. Meanwhile, in an analysis of subgroups, both subjects with angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) use were lower incidence of AD (RR, 0.87; 95% CI 0.74-1.00; RR, 0.69; 95% CI 0.44-0.93, respectively) than those without, whereas, indirect comparison between ACEI and ARB revealed no significance in the risk of AD (RR, 1.27, 95% CI 0.85-1.89, p=0.245). In an analysis of cognitive impairment of aging, ARB use (RR, 0.40; 95% CI 0.02-0.78), rather than ACEI use (RR, 0.72; 95% CI 0.36-1.09), was shown to decrease the risk of cognitive impairment of aging. In conclusion, RASB treatments, regardless of the drug class, have benefits on prevention of AD, and the effects of ACEI may analogous to ARB. However, the benefit differs according to drug classes for cognitive impairment of aging, with ARB use, rather than ACEI use, being a potential treatment for reducing the incidence of cognitive impairment of aging.

Renin-angiotensin system blockade use and risks of cognitive decline and dementia: A meta-analysis.

OBJECTIVE: To evaluate the effects of renin-angiotensin system blockade (RASB) and its classes on the incidences of cognitive decline and dementia. METHODS: PubMed, the EMBASE database and Cochrane Library were searched through October 2015 for eligible studies. We included ten studies that analyzed the effects of RASB treatment on the incidence of cognitive decline or dementia. RESULTS: We found that the use of RASB was associated with a reduced risk of dementia (RR, 0.84; 95% CI, 0.76-0.92), when randomized trials and observational trials were considered together. Meanwhile, regardless of the drug class, both the angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) were shown to effectively decrease the incidence rate of dementia (RR, 0.89; 95% CI, 0.82-0.96; RR, 0.79; 95% CI, 0.64-0.94, respectively). Furthermore, indirect comparison between ACEIs and ARBs revealed no correlation in incident dementia (RR, 0.89, 95% CI 0.72-1.09, p=0.26). However, centrally acting ACEIs (CACEIs) protected against the occurrence of dementia (RR, 0.94; 95% CI, 0.91-0.97); on the contrary, peripheral ACEIs (PACEIs) increased the risk of dementia (RR, 1.20; 95% CI, 1.00-1.43). In an analysis of cognitive decline, CACEIs use was shown to decrease the risk of cognitive decline (RR, 0.92; 95% CI, 0.83-1.00); however, ARBs use had no significant association with the risk of cognitive decline (RR, 0.98; 95% CI, 0.90-1.05). CONCLUSIONS: RASB antihypertensive drugs may be potential treatments for reducing the incidence of dementia, but ARBs use is likely to be analogous to ACEIs. The association of dementia with CACEIs and PACEIs may be opposite, with CACEIs being effective. Meanwhile, the benefit differing according to drug classes for cognitive decline, CACEIs use, rather than ARBs use, is likely to play protective role in cognitive decline.

Renin-angiotensin system-targeting antihypertensive drugs and risk of vascular cognitive impairment: A meta-analysis.

OBJECTIVES: To evaluate the effects of renin-angiotensin system (RAS)-targeting antihypertensive drugs and its classes on the incidence of vascular cognitive impairment (VCI). METHODS: Pubmed, Embase, and Cochrane Library database of selected articles, and previous systematic reviews through May 2015 were searched. Studies that evaluated the association between use of RAS-targeting drugs and VCI were included. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using fixed effects models or random effects models. RESULTS: In all studies as a whole, the use of RAS-targeting drugs was significantly associated with a reduced risk of VCI (RR, 0.87; 95% CI, 0.75-0.98) and vascular dementia (VD) (RR, 0.78; 95% CI, 0.64-0.93), compared no use of RAS-targeting drugs. Subgroup analysis showed that subjects with Angiotensin-Converting Enzyme Inhibitors (ACEI) use significantly associated with a reduced incidence of VCI (RR, 0.81; 95% CI 0.70-0.91) and VD (RR, 0.75; 95% CI, 0.57-0.93); however, subjects with Angiotensin Receptor Blockers (ARB) use had not this effect on VCI (RR, 0.94; 95% CI 0.76-1.13) or VD (RR, 0.94; 95% CI, 0.45-1.44). In an analysis of subgroups, case-control studies found that the use of RAS-targeting drugs could effectively decrease the incidence of VCI (RR, 0.77; 95% CI 0.66-0.87) and VD (RR, 0.77; 95% CI, 0.66-0.88); however, the randomized trials alone showed no significant effect on the incidence of VCI (RR, 0.94; 95% CI 0.82-1.07) or VD (RR, 0.94; 95% CI, 0.35-1.53). Meanwhile, in an analysis of cognitive impairment of vascular origin (VaCI), no significant association was found between RAS-targeting drugs, ACEI, or ARB and the incidence of VaCI. CONCLUSION: RAS-targeting drugs treatment may produce remarkable efficacy on reducing the incidence of VCI and VD. Meanwhile, ACEI use, rather than ARB use, significantly protects against VCI and VD incidence. However, among the classes of RAS-targeting drugs, neither ACEI nor ARB plays protective role in VaCI incidence. Further more RCTs are required to reliably establish whether RAS-targeting drugs use decreases the risk of VCI (VD and VaCI).

Current status of antiplatelet treatment before and after ischemic stroke, and an analysis of factors associated with antiplatelet treatment, in the Qingdao area of China.

BACKGROUND: Stroke is the most common neurological disease in China, and antiplatelet treatment is important for primary and secondary prevention. This study aimed to describe the current status of antiplatelet treatment before, immediately after, and 1 month after ischemic stroke in the Qingdao area of China, and to determine the factors and potential barriers influencing use. METHODS: A total of 1114 patients with acute ischemic stroke were enrolled from 11 hospitals in the Qingdao area. Patient demographic data, clinical data, and treatment before and after the stroke were recorded. Univariate analysis (two sample t-test or Mann-Whitney U test, and chi-square test) and multivariate Logistic regression analysis were used to determine the frequency of antiplatelet treatment, and factors associated with treatment, at three time points: before the stroke, in hospital after the stroke, and at 1-month follow-up. RESULTS: The frequency of antiplatelet treatment was 6.4% before the stroke, 91.5% in hospital, and 77.2% at 1 month. Aspirin pretreatment was independently associated with higher education level, higher income level, history of hyperlipidemia, and history of cerebral vascular disease. Antiplatelet treatment in hospital was independently associated with treatment in an urban hospital, National Institutes of Health Stroke Scale at onset, and statin use in hospital. Antiplatelet treatment at 1-month follow-up was independently associated with higher income level, diagnosis of transient ischemic attack, antiplatelet treatment in hospital, large artery atherosclerosis according to the Trial of Org 10172 in Acute Stroke Treatment classification, and statin use at follow-up. Modified Rankin Scale ≥ 4 at 1-month follow-up and history of coronary heart disease were negatively associated with antiplatelet treatment at follow-up. CONCLUSIONS: This study documents the current status of antiplatelet treatment in primary and early secondary prevention of ischemic stroke in China. Further education of clinicians and the public about stroke prevention is important.