Dopamine agonists and the risk of cardiac-valve regurgitation.
BACKGROUND
Case reports and echocardiographic studies suggest that the ergot-derived dopamine agonists pergolide and cabergoline, used in the treatment of Parkinson's disease and the restless legs syndrome, may increase the risk of cardiac-valve regurgitation.


METHODS
We used data from the United Kingdom General Practice Research Database to identify a population-based cohort comprising 11,417 subjects 40 to 80 years of age who were prescribed antiparkinsonian drugs between 1988 and 2005. We conducted a nested case-control analysis within this cohort in which each patient with newly diagnosed cardiac-valve regurgitation was matched with up to 25 control subjects from the cohort, according to age, sex, and year of entry into the cohort. Incidence-rate ratios for cardiac-valve regurgitation with the use of different dopamine agonists were estimated by conditional logistic-regression analysis.


RESULTS
Of 31 case patients with newly diagnosed cardiac-valve regurgitation, 6 were currently exposed to pergolide, 6 were currently exposed to cabergoline, and 19 had not been exposed to any dopamine agonist within the previous year. The rate of cardiac-valve regurgitation was increased with current use of pergolide (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 dopamine agonists.


CONCLUSIONS
In this study, use of the dopamine agonists pergolide and cabergoline was associated with an increased risk of newly diagnosed cardiac-valve regurgitation.
Schade
René
R
Department of Clinical Pharmacology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin.
Andersohn
Frank
F
Suissa
Samy
S
Haverkamp
Wilhelm
W
Garbe
Edeltraut
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000009:adverse effects; D000077465:Cabergoline; D016022:Case-Control Studies; D015331:Cohort Studies; D018491:Dopamine Agonists / Q000009:adverse effects*; D004873:Ergolines / Q000009:adverse effects*; D005260:Female; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy; D010479:Pergolide / Q000009:adverse effects*; D058826:Serotonin 5-HT2 Receptor Agonists; D017366:Serotonin Receptor Agonists / Q000009:adverse effects
D000978:Antiparkinson Agents; D018491:Dopamine Agonists; D004873:Ergolines; D058826:Serotonin 5-HT2 Receptor Agonists; D017366:Serotonin Receptor Agonists; D010479:Pergolide; D000077465:Cabergoline