Background Case reports and echocardiographic studies suggestthat the ergot-derived dopamine agonists pergolide and cabergoline,used in the treatment of Parkinson's disease and the restlesslegs syndrome, may increase the risk of cardiac-valve regurgitation.
Methods We used data from the United Kingdom General PracticeResearch Database to identify a population-based cohort comprising11,417 subjects 40 to 80 years of age who were prescribed antiparkinsoniandrugs between 1988 and 2005. We conducted a nested case–controlanalysis within this cohort in which each patient with newlydiagnosed cardiac-valve regurgitation was matched with up to25 control subjects from the cohort, according to age, sex,and year of entry into the cohort. Incidence-rate ratios forcardiac-valve regurgitation with the use of different dopamineagonists were estimated by conditional logistic-regression analysis.
Results Of 31 case patients with newly diagnosed cardiac-valveregurgitation, 6 were currently exposed to pergolide, 6 werecurrently exposed to cabergoline, and 19 had not been exposedto any dopamine agonist within the previous year. The rate ofcardiac-valve regurgitation was increased with current use ofpergolide (incidence-rate ratio, 7.1; 95% confidence interval[CI], 2.3 to 22.3) and cabergoline (incidence-rate ratio, 4.9;95% CI, 1.5 to 15.6), but not with current use of other dopamineagonists.
Conclusions In this study, use of the dopamine agonists pergolideand cabergoline was associated with an increased risk of newlydiagnosed cardiac-valve regurgitation.
Source Information
From the Department of Clinical Pharmacology, Charité Campus Mitte (R.S., F.A., E.G.), and the Department of Cardiology, Charité Campus Virchow (W.H.), Charité-Universitätsmedizin Berlin, Berlin; and the McGill Pharmacoepidemiology Research Unit, Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, Montreal (S.S.).
Dopamine Agonists and Valvular Heart Disease
Stephens J. W., Price D. E., Ionescu A., Linkova H., Ruzicka E., Penicka M., Kast R. E., Altschuler E. L., Ziegler J. L., Bukhman G. Y., Sartiani L., Cerbai E., Mugelli A., Schade R., Andersohn F., Garbe E., Zanettini R., Pezzoli G., Roth B. L.
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N Engl J Med 2007;
356:1676-1680, Apr 19, 2007.
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