RT Journal Article SR Electronic T1 Drug-associated valvular heart diseases and serotonin-related pathways: a meta-analysis JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 1140 OP 1148 DO 10.1136/heartjnl-2018-314403 VO 105 IS 15 A1 Jacqueline H Fortier A1 Beatrice Pizzarotti A1 Richard E Shaw A1 Robert J Levy A1 Giovanni Ferrari A1 Juan Grau YR 2019 UL http://heart.bmj.com/content/105/15/1140.abstract AB Objective Serotonergic appetite suppressants and ergot-derived dopamine agonists have been associated with drug-induced valvular heart disease. The purpose of this meta-analysis is to synthesise the current evidence of a link between several medications affecting sertonergic pathways and valvular heart disease.Methods PubMed was searched to identify studies evaluating an association between medications with serotonergic activity and cardiac valvular pathology. Case reports, uncontrolled studies and in vitro studies were excluded. Relevant studies were assessed for quality and potential bias; those of adequate quality were included in a quantitative synthesis. Sensitivity analyses were conducted, and potential publication bias was examined.Results There was a consistent, significant relationship between certain medications and heart valve disease, including serotonergic medications (OR 3.30, 95% CI 1.99 to 5.49) and dopaminergic medications (OR 2.56, 95% CI 1.68 to 3.91). Subanalyses, including analyses that limited exposure to a single medication or effects to a single heart valve were also consistently significant. Most studies were retrospective or observational in nature, with a higher risk of selection and presentation biases. There was significant heterogeneity and variability between studies, particularly when it came to dose and duration of exposure.Conclusions There was a consistent, significant association between many medications that affect serotonergic pathways and valvular heart disease. Although many of these medications have been withdrawn from the market, some small studies suggest that recreational drug 3,4-methylenedioxy​methamphetamine and widely prescribed selective serotonin reuptake inhibitors may affect similar pathways.