Dopamine Agonists and the Risk of Cardiac-Valve Regurgitation

• Published in: The New England journal of medicine Vol. 356; no. 1; pp. 29 - 38
• Main Authors: Schade, René, Andersohn, Frank, Suissa, Samy, Haverkamp, Wilhelm, Garbe, Edeltraut
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 04.01.2007
• Subjects: Adult; Aged; Aged, 80 and over; Antiparkinson Agents - adverse effects; Biological and medical sciences; Case-Control Studies; Cohort Studies; Dopamine Agonists - adverse effects; Drug abuse; Ergolines - adverse effects; Family physicians; Female; General aspects; Heart Valve Diseases - chemically induced; Heart Valve Diseases - diagnosis; Hospitals; Humans; Informed consent; Logistic Models; Male; Medical research; Medical sciences; Middle Aged; Parkinson Disease - complications; Parkinson Disease - drug therapy; Patients; Pergolide - adverse effects; Risk; Serotonin 5-HT2 Receptor Agonists; Serotonin Receptor Agonists - adverse effects; Medicine; Cardiovascular disease; Heart valve; Dopamine agonist; Cardiovascular risk
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa062222

The association between antiparkinsonian drugs and cardiac-valve regurgitation was assessed in a nested case–control study from a large general-practice database in the United Kingdom. The rate of cardiac-valve regurgitation was increased with current use of pergolide (incidence-rate ratio, 7.1) or cabergoline (incidence-rate ratio, 4.9) but not with current use of other dopamine agonists. Clinicians should consider the risk of valvular heart disease when prescribing these agents. The rate of cardiac-valve regurgitation was increased with current use of pergolide or cabergoline but not with other dopamine agonists. About 1% of members of the U.S. population who are older than 60 years have Parkinson's disease. 1 Dopamine agonists are first-line agents for the treatment of Parkinson's disease. 1 They are also prescribed for patients with the restless legs syndrome 2 and for those with hyperprolactinemic disorders. An association has been reported between treatment with the dopamine agonist pergolide (Permax, Eli Lilly) and the development of fibrotic valvular heart disease, particularly when pergolide was administered in high doses over long periods. 3 – 7 On echocardiography, patients had mild-to-severe cardiac-valve regurgitation, often involving more than one valve. Histologic findings have been found to resemble . . .