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Do dopamine agonists cause valvular heart disease? ▸
Previous studies have suggested that the ergot-derived dopamine agonists pergolide and cabergoline may be associated with an increased risk of cardiac valve regurgitation. In addition, histological series have demonstrated valve abnormalities similar to those observed in carcinoid heart disease. Data from the UK General Practice Research Database were used to identify 11 417 individuals aged 40–80 years prescribed anti-parkinsonian dopamine agonist drugs over a 17-year period from 1988 to 2005. A total of 81 patients with newly diagnosed cardiac valve regurgitation were identified, of whom 50 were excluded. Of the remaining 31, six were currently taking pergolide, six cabergoline and 19 had not been exposed to a dopamine agonist within the preceding year. When compared with controls, the rate of cardiac valve regurgitation was increased with current use of pergolide (incident rate ratio 7.1, 95% CI 2.3 to 22.3) and cabergoline (incident rate ratio 4.9, 95% CI 1.5 to 15.6), but not with the use of other dopamine agonists. The risk was particularly high in patients who had taken daily doses of pergolide or cabergoline >3 mg/day, but only among individuals who had taken either drug for >6 months. One concurrent medication, amantadine, was also identified as a risk factor (adjusted incidence ratio 3.5, 95% CI 1.1 to 11.3). In a second paper, an echocardiographic prevalence study was performed on 155 patients taking dopamine agonists for Parkinson’s disease (pergolide n = 64, cabergoline n = 49 and non-ergot-derived dopamine agonists n = 42). Among patients treated with ergot-derived dopamine agonists, 17 cases of localised or diffuse leaflet thickening were identified in those treated with pergolide and 8 in those prescribed cabergoline. No cases of leaflet thickening were found in either the non-ergot or the control group. Clinically significant valvular regurgitation (moderate to severe, grade 3–4) was demonstrated in 23.4% of individuals taking pergolide and in 28.6% …