This study aims to  investigate the potential association between sacubitril/valsartan use and dementia risk compared to treatment with ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in heart failure patients.

Seven studies, involving 129,265 participants, were included in our analysis. The Sacubitril/valsartan group showed significantly lower odds of developing overall dementia and vascular dementia compared to those receiving ACEIs or ARBs (OR = 0.78; 95% CI: 0.70–0.87; P < 0.00001; I² = 39% and OR = 0.70; 95% CI: 0.56–0.86; P = 0.0007; I² = 0%, respectively). Additionally, Sacubitril/valsartan was associated with reduced incidence of Alzheimer’s disease (OR = 0.76; 95% CI: 0.56–1.00; P = 0.08; I² = 74%) and other dementias (OR = 0.72; 95% CI: 0.53–0.99; P = 0.04; I² = 59%).

This meta-analysis suggests that sacubitril/valsartan is associated with a lower risk of developing overall dementia, including Alzheimer’s disease, vascular dementia, and other dementias, compared to ACEIs or ARBs in heart failure patients. These findings support the cognitive safety of sacubitril/valsartan, though further high-quality studies are needed to confirm its long-term neurological effects.