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Cabergoline therapy and the risk of cardiac valve regurgitation in patients with hyperprolactinemia: A metaanalysis from clinical studies

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Abstract

Dopamine agonists have been associated with increased risk of cardiac valve regurgitation in patients with Parkinson’s disease. Whether these drugs might be harmful for patients with hyperprolactinemia is still unsettled. Occasional case reports and 7 studies on the relationship between cabergoline and cardiac valve regurgitation have been published so far. Overall, cabergoline has been considered a safe therapy, although some studies suggested an increased prevalence of cardiac valve regurgitation. The aim of this meta-analysis was to assess the effects of cabergoline on cardiac valve regurgitation. Eligible studies were all trials using cabergoline in patients with either tumor or non-tumor hyperprolactinemia. Our search was updated to October 2008. Pooled data from the 6 selected studies showed that treatment with cabergoline was associated with increased risk of tricuspid valve regurgitation (fixed effects: prevalence ratio=1.40; 95% confidence interval: 1.17-1.67); on the contrary, patients treated with cabergoline and control subjects did not differ in prevalence of aortic or mitral valve regurgitation. This meta-analysis shows that patients with hyperprolactinemia treated with cabergoline are at increased risk of regurgitation of the tricuspid valve. However, regurgitation was only an echocardiographic finding since no patient had symptoms of valvular disease. This meta-analysis underscores that echocardiography is recommended in all patients with hyperprolactinemia who are candidate to be treated with or are under cabergoline therapy; monitoring cardiac valves is also recommended although precise follow-up for these patients will be likely provided by future longitudinal studies.

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References

  1. Colao A, Di Sarno A, Guerra E, De Leo M, Mentone A, Lombardi G. Drug insight: cabergoline and bromocriptine in the treatment of hyperprolactinemic men and women. Nat Clin Pract Endocrinol Metab 2006, 2: 200–10.

    Article  PubMed  CAS  Google Scholar 

  2. Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G. Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N Engl J Med 2007, 356: 39–46.

    Article  PubMed  CAS  Google Scholar 

  3. Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E. Dopamine agonists and the risk of cardiac-valve regurgitation. N Engl J Med 2007, 356: 29–38.

    Article  PubMed  CAS  Google Scholar 

  4. Rothman RB, Baumann MH, Savage JE, et al. Evidence for possible involvement of 5-HT2B receptors in the cardiac valvulopathy associated with fenfluramine and other serotoninergic medications. Circulation 2000, 102: 2836–41.

    Article  PubMed  CAS  Google Scholar 

  5. Bhattacharyya S, Davar J, Dreyfus G, Caplin ME. Carcinoid heart disease. Circulation 2007, 116: 2860–5.

    Article  PubMed  Google Scholar 

  6. Bogazzi F, Buralli S, Manetti L, et al. Treatment with low doses of cabergoline is not associated with increased prevalence of cardiac valve regurgitation in patients with hyperprolactinemia. Int J Clin Pract 2008, 62: 1864–69.

    Article  PubMed  CAS  Google Scholar 

  7. Vallette S, Serri K, Rivera J, et al. Long-term cabergoline therapy in not associated with valvular heart disease in patients with prolactinomas. Pituitary 2008, July 2 [Epub ahead of print]; doi: 10.1007/s11102-008-0134-2.

  8. Lancellotti P, Livadariu E, Markov M, et al. Cabergoline and risk of valvular lesions in endocrine disease. Eur J Endocrinol 2008, 159: 1–5.

    Article  PubMed  CAS  Google Scholar 

  9. Herring N, Szmigielski C, Becher H, Karavitaki N, Wass JAH. Valvular heart disease and the use of cabergoline forthe treatment of prolactinoma. Clin Endocrinol 2008, Oct 21 [Epub ahead of print]; doi: 10.1111/j.1365-2265.2008.03458.x.

  10. Kars M, Delgado V, Holman ER, et al. Aortic valve calcification and mild tricuspid regurgitation, but no clinical heart disease after 8 years of dopamine agonist therapy for prolactinoma. J Clin Endocrinol Metab 2008, 93: 3348–56.

    Article  PubMed  CAS  Google Scholar 

  11. Wakil A, Rigby AS, Clark AL, Kallvikbacka-Bennett A, Atkin SL. Low dose cabergoline for hyperprolactinemia is not associated with clinically significant valvular heart disease. Eur J Endocrinol 2008, 159: R11–4.

    Article  PubMed  CAS  Google Scholar 

  12. Colao A, Galderisi M, Di Sarno A, et al. Increased prevalence of tricuspid regurgitation in patients with prolactinomas chronically treated with cabergoline. J Clin Endocrinol Metab 2008, 93: 3777–84.

    Article  PubMed  CAS  Google Scholar 

  13. Flowers CM, Racoosin JA, Lu SL, Beitz JG. The US food and Drugs Administration’s registry of patients with pergolide-associated valvular heart disease. Mayo Clin Proc 2003, 78: 730–1.

    Article  PubMed  Google Scholar 

  14. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003, 16: 777–802.

    Article  PubMed  Google Scholar 

  15. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986, 7: 177–88.

    Article  PubMed  CAS  Google Scholar 

  16. Fitzgerald LW, Burn TC, Brown BS, et al. Possible role of valvular serotonin 5-HT(2B) receptors in the cardiopathy associated with fenfluramine. Mol Pharmacol 2000, 57: 75–81.

    PubMed  CAS  Google Scholar 

  17. Simonis G, Fuhrmann JT, Strasser RH. Meta-analysis of heart valve abnormalities in Parkinson’s disease patients treated with dopamine agonists. Mov Disord 2007, 22: 1936–42.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, Via Paradisa 2, 56124, Pisa, Italy

    F. Bogazzi MD, L. Manetti, V. Raffaelli, M. Lombardi & E. Martino

  2. Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council (C.N.R.), Pisa, Italy

    G. Rossi

Authors
  1. F. Bogazzi MD
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  2. L. Manetti
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  3. V. Raffaelli
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  4. M. Lombardi
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  5. G. Rossi
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  6. E. Martino
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Correspondence to F. Bogazzi MD.

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Bogazzi, F., Manetti, L., Raffaelli, V. et al. Cabergoline therapy and the risk of cardiac valve regurgitation in patients with hyperprolactinemia: A metaanalysis from clinical studies. J Endocrinol Invest 31, 1119–1123 (2008). https://doi.org/10.1007/BF03345662

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  • DOI: https://doi.org/10.1007/BF03345662

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