MRC Unit for Lifelong Health and Ageing at UCL, London, UK.
Barts and The London School of Medicine and Dentistry, London, UK.
J Alzheimers Dis. 2019;71(4):1105-1114. doi: 10.3233/JAD-190503.
Cardiovascular disease remains the most common cause of death in industrialized countries. The use of beta-blockers is well established as a secondary prevention of myocardial infarction. However, little is known about the benefits of beta-blockers for people living with dementia.
To evaluate the use of beta-blockers in people with dementia who have had a myocardial infarction, in order to identify associations between medication use, mortality, re-infarction and functional decline.
We searched for all studies (randomized trials, observational cohorts) reporting beta-blocker use in populations with both dementia and previous myocardial infarction. Relevant keywords were used in Medline, Embase, and Web of Science up to October 2018. Titles and abstracts were independently screened by two reviewers. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale. PRISMA recommendations were followed throughout.
Two observational studies were included, representing 10,992 individuals in a community setting and 129,092 individuals from a hospital record-linkage study. One showed use of beta-blockers reduced all-cause mortality (HR 0.74 (95% CI 0.64- 0.86) alongside evidence for an increased rate of functional decline in individuals aged≥65 with moderate to severe cognitive impairment (OR 1.34 (95% CI 1.11- 1.61)). The second study did not find an association between beta-blocker use and mortality in the population living with dementia.
There is insufficient evidence to support use of beta-blockers to persons living with dementia. A single study provides limited evidence that beta-blockers improve survival rates but with associated detrimental effects on functional status in nursing home residents with cognitive impairment. Decisions to continue beta-blockers in persons living with dementia should be made on an individual basis.
心血管疾病仍然是工业化国家最常见的死亡原因。β受体阻滞剂已被广泛用于心肌梗死后的二级预防。然而，关于β受体阻滞剂对痴呆患者的益处知之甚少。
评估心肌梗死后患有痴呆症的患者使用β受体阻滞剂的情况，以确定药物使用、死亡率、再梗死和功能下降之间的关联。
我们搜索了所有报告β受体阻滞剂在同时患有痴呆症和先前心肌梗死的人群中使用的研究（随机试验、观察队列）。使用 Medline、Embase 和 Web of Science 中的相关关键字，检索截至 2018 年 10 月的研究。两名评审员独立筛选标题和摘要。使用纽卡斯尔-渥太华量表评估合格研究的质量。整个过程均遵循 PRISMA 建议。
纳入了两项观察性研究，分别代表社区环境中的 10992 人和医院病历链接研究中的 129092 人。其中一项研究表明，β受体阻滞剂的使用降低了全因死亡率（HR 0.74（95%CI 0.64-0.86），同时伴有中度至重度认知障碍的 65 岁及以上个体功能下降率增加（OR 1.34（95%CI 1.11-1.61））。第二项研究未发现β受体阻滞剂的使用与痴呆人群的死亡率之间存在关联。
没有足够的证据支持在痴呆患者中使用β受体阻滞剂。一项研究提供了有限的证据表明β受体阻滞剂可以提高生存率，但伴有认知障碍的养老院居民功能状态的不利影响。是否继续在痴呆患者中使用β受体阻滞剂应根据个体情况决定。
