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Bromocriptine use and the risk of valvular heart disease

Louis C S Tan1, Kenneth K C Ng, Wing-Lok Au

  • 1Parkinson's Disease and Movement Disorders Centre, National Neuroscience Institute, Singapore. louis_tan@nni.com.sg

Movement Disorders : Official Journal of the Movement Disorder Society
|November 8, 2008
PubMed

Insights

Parkinson's disease patients taking bromocriptine, a dopamine agonist, face an increased risk of valvular heart disease. This risk is dose-dependent, similar to pergolide, highlighting potential cardiovascular concerns with these medications.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Pergolide and cabergoline are known to increase valvular heart disease (VHD) risk in Parkinson's disease (PD) patients.
  • Bromocriptine, another dopamine agonist (DA) derived from ergot, has partial 5-HT(2B) activity, raising questions about its VHD risk.
  • The association between bromocriptine and VHD remains uncertain.

Purpose of the Study:

  • To assess the frequency of VHD in PD patients treated with bromocriptine.
  • To compare the VHD risk in bromocriptine users versus pergolide users and a control group of PD patients not on DAs.
  • To investigate the relationship between cumulative bromocriptine dose and VHD development.

Main Methods:

  • A comparative study involving 72 PD patients on bromocriptine, 21 on pergolide, and 47 controls.
  • Transthoracic echocardiography was performed on all participants.
  • Echocardiographic studies were independently reviewed by a blinded cardiologist.

Main Results:

  • Bromocriptine users showed a 3.32-fold increased risk of abnormal valvular regurgitation compared to controls (adjusted OR, 1.11-9.92; P=0.03).
  • Pergolide users had a 3.66-fold increased risk (adjusted OR, 1.22-10.97; P=0.02).
  • Higher cumulative bromocriptine doses correlated significantly with increased risk of mild and moderate-severe regurgitations (P for trend, 0.005 and 0.019).

Conclusions:

  • Bromocriptine use is associated with an elevated risk of developing valvular heart disease in Parkinson's disease patients.
  • The risk of VHD associated with bromocriptine is cumulative and dose-dependent.
  • These findings suggest careful monitoring for VHD in PD patients using bromocriptine, particularly with long-term or high-dose therapy.

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