Ischemic stroke risk in patients with dopamine agonist-treated hyperprolactinemia

Data on the risk of stroke in patients with hyperprolactinemia are limited. This study aimed to evaluate the association between hyperprolactinemia and ischemic stroke in a large cohort and identify predictors of stroke in this population. This was a retrospective cohort study comparing the incidence of ischemic stroke in patients with dopamine agonist-treated hyperprolactinemia to matched controls in a 1:5 ratio. The primary outcome was the diagnosis of ischemic stroke. The cohort included 2440 patients with DA-treated hyperprolactinemia patients (mean age ± SD: 38.42 ± 14.57 years, 60.2% women) matched to 12,022 controls (mean age ± SD: 38.15 ± 14.36 years, 60.8% women). Ischemic stroke occurred in 195 patients with hyperprolactinemia (8.0%) and 747 controls (6.21%) (adjusted HR 1.24, 95% CI 1.06-1.46). Patients with hyperprolactinemia developed stroke at a younger age (57.75 ± 15.88 years vs. 60.18 ± 15.20 years, p = .05). Patients with PRL levels >5× ULN at diagnosis had a higher stroke incidence than those with lower levels (9.73% vs. 6.85%; HR 1.48, 95% CI 1.11-1.97). Longer time to prolactin normalization was associated with a higher incidence of stroke (median 21.88 vs. 13.78 months; p = .0005). In multivariate analysis, age ≥60 years, male gender, hypertension, type 1 or type 2 diabetes mellitus, and ischemic heart disease were significant predictors of stroke in patients with hyperprolactinemia. Dopamine agonist-treated hyperprolactinemia is associated with an increased risk of ischemic stroke compared to well-matched controls from the general population. Higher prolactin levels at diagnosis and a longer time to normalization were linked to a greater risk of stroke.