title: Bromocriptine use and the risk of valvular heart disease.
abstract: It has been reported that patients on pergolide and carbergoline have an increased risk of developing valvular heart disease. It is uncertain if bromocriptine, an ergot-derived dopamine agonist (DA) with partial 5-HT(2B) activity, is associated with a similar risk. We assessed the frequency of valvular heart disease in Parkinson's disease (PD) patients on bromocriptine compared to pergolide and a control group of PD patients who had not been treated on any DA. Seventy-two PD patients on bromocriptine, 21 patients on pergolide, and 47 control PD patients were recruited. Transthoracic echocardiographic studies were performed and reviewed by a blinded cardiologist. The risk for the bromocriptine group to develop any abnormal valvular regurgitation was 3.32 (adjusted OR, 95% CI: 1.11-9.92, P = 0.03) compared to controls, whereas the risk for the pergolide group was 3.66 (adjusted OR, 95% CI: 1.22-10.97, P = 0.02). When cumulative dose of bromocriptine was analyzed by quartiles, patients with a greater exposure to bromocriptine had significantly higher risk of developing both mild and moderate-severe regurgitations (P for trend, 0.005 and 0.019, respectively). This study demonstrated that bromocriptine use was associated with an increased risk of developing valvular heart disease, which occurred in a cumulative dose-dependent manner.
authors.affiliation: Parkinson's Disease and Movement Disorders Centre, National Neuroscience Institute, Singapore. louis_tan@nni.com.sg
authors.forename: Louis C S
authors.initials: LC
authors.lastname: Tan
authors.forename: Kenneth K C
authors.initials: KK
authors.lastname: Ng
authors.forename: Wing-Lok
authors.initials: WL
authors.lastname: Au
authors.forename: Raymond K K
authors.initials: RK
authors.lastname: Lee
authors.forename: Yiong-Huak
authors.initials: YH
authors.lastname: Chan
authors.forename: Nigel C K
authors.initials: NC
authors.lastname: Tan
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000139:chemically induced / Q000175:diagnosis / Q000235:genetics; D001971:Bromocriptine / Q000008:administration & dosage / Q000009:adverse effects*; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D015150:Echocardiography, Doppler; D005260:Female; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000235:genetics; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000139:chemically induced / Q000175:diagnosis / Q000235:genetics; D010300:Parkinson Disease; D044403:Receptor, Serotonin, 5-HT2B / Q000187:drug effects / Q000235:genetics; D012307:Risk Factors; D012720:Severity of Illness Index; D014262:Tricuspid Valve Insufficiency / Q000139:chemically induced / Q000175:diagnosis / Q000235:genetics
chemical_list: D018491:Dopamine Agonists; D044403:Receptor, Serotonin, 5-HT2B; D001971:Bromocriptine