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Dopamine agonists and cardiac valvulopathy in Parkinson disease

A case–control study

From the Departments of Neurology (M.Y.) and Cardiology (T.U.), Kagawa Prefectural Central Hospital, Takamatsu; and Department of Health Informatics (T.N.), Kyoto University School of Public Health, Kyoto, Japan.

Address correspondence and reprint requests to Dr. Mitsutoshi Yamamoto, Department of Neurology, Kagawa Prefectural Central Hospital, 5-4-16 Bancho, Takamatsu 760-8557, Japan; e-mail: dryama{at}mail.netwave.or.jp

Objective: To determine the frequency of cardiac valvulopathy in patients with Parkinson disease (PD) treated with or without dopamine agonists.

Methods: We obtained transthoracic echocardiography and EKG in 210 consecutive patients with PD admitted to our hospital between September 2004 and September 2005. We analyzed the frequency according to the type of dopamine agonist. A case–control design was adopted with dopamine agonist nontreated group as the reference group, and multiple logistic regression analysis was conducted considering age, sex, and duration of illness to examine the relationships between each dopamine agonist and the presence of valvular abnormalities.

Results: The frequency of valvulopathy was significantly higher in the cabergoline-treated group (68.8%, 11/16; affected patients/total) than in the dopamine agonist nontreated control group (17.6%, 15/85). The frequency was not different between the pergolide group (28.8%, 19/66) and the pramipexole group (25%, 4/16). The adjusted odds ratio was significantly higher in the cabergoline group (12.96, 95% CI = 3.59 to 46.85), compared with the pergolide group (2.18, 95% CI = 0.90 to 5.30) and pramipexole group (1.62, 95% CI = 0.45 to 5.87). The mean daily dose was 3.8 mg for cabergoline, 1.4 mg for pergolide, and 1.7 mg for pramipexole. The cumulative dose and treatment duration of cabergoline in the valvulopathy subgroup were significantly higher than in the nonvalvulopathy subgroup.

Conclusion: The frequency of valvulopathy was significantly increased in the cabergoline group. Our results indicate that high cumulative dose and long-term treatment with cabergoline are risk factors for valvulopathy in patients with Parkinson disease.

Disclosure: The authors report no conflicts of interest.

Author contributions: M. Yamamoto designed this study and obtained informed consent for participation in this study from patients with Parkinson disease (for whom he served as the attending physician) and is the principal investigator and author of this article. T. Uesugi evaluated echocardiograms and served as a coauthor. T. Nakayama analyzed the results and conducted statistical analysis and served as a coauthor of this article.

Received January 17, 2006. Accepted in final form May 30, 2006.

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