Pergolide associated cardiac valvulopathy based on Ontario administrative data.
BACKGROUND
Pergolide is an ergot derived dopamine agonist that is widely used for the treatment of Parkinson's disease. Studies have found an association between pergolide and valvular heart abnormalities although there is still much to be learned about the clinical significance of the valvular changes, who is at risk, and whether there is duration of exposure effect.


OBJECTIVE
To assess the long term risk of hospital admissions for valvular heart disease (VHD) or congestive heart failure (CHF, a clinically overt outcome of VHD) in new users of pergolide compared to new users of levodopa. The secondary objective was to assess whether there are any characteristics that can predict who is at higher risk of developing this outcome.


METHODS
Retrospective, population-based cohort study.


METHODS
Ontario, Canada.


METHODS
Ontario residents aged 66 and older, newly started on treatment with either pergolide or levodopa.


RESULTS
Admission to hospital with the most responsible diagnosis of congestive heart failure or valvular heart disease.


RESULTS
The risk for admission for valvular heart disease or congestive heart failure were higher in those with 1-4 years exposure to pergolide compared with no exposure to pergolide (VHD: hazard ratio 2.4, p = 0.04; CHF: hazard ratio 1.6, p = 0.02). No such pattern was found with exposure to levodopa.


CONCLUSIONS
Our study demonstrates that treatment with pergolide is associated with a higher risk of hospital admission for valvular heart disease or congestive heart failure and that this risk is greater in those with 1-4 years exposure than in those with less exposure. We did not find an increased risk beyond four years.
Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Department of Neurology, Toronto, Ontario, Canada.
Cindy
C
Zadikoff
Minh
M
Duong-Hua
Kathy
K
Sykora
Connie
C
Marras
Anthony
A
Lang
Paula
P
Rochon
D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D016208:Databases, Factual / Q000706:statistics & numerical data; D018491:Dopamine Agonists / Q000009:adverse effects*; D005260:Female; D006298:Health Services Administration / Q000706:statistics & numerical data; D006333:Heart Failure / Q000139:chemically induced*; D006349:Heart Valve Diseases / Q000139:chemically induced*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D009864:Ontario; D010300:Parkinson Disease / Q000188:drug therapy; D010479:Pergolide / Q000009:adverse effects*
D000978:Antiparkinson Agents; D018491:Dopamine Agonists; D010479:Pergolide; D007980:Levodopa