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Mortality in patients with dopamine agonist-treated hyperprolactinemia: a large matched-cohort study
Irit Ayalon-Dangur1,2, Ilan Shimon1,2, Tzipora Shochat3
1Institute of Endocrinology, Rabin Medical Center Beilinson Campus, Petah Tikva, 49100, Israel.
Insights
Mortality risk in dopamine agonist-treated hyperprolactinemia patients is similar to controls. Achieving prolactin normalization within a year and lower baseline prolactin levels reduce mortality risk, especially in women.
Area of Science:
- Endocrinology
- Clinical Medicine
- Epidemiology
Background:
- Hyperprolactinemia, a condition of elevated prolactin levels, affects a significant population.
- Limited data exists on the long-term mortality risks associated with hyperprolactinemia, particularly in patients treated with dopamine agonists (DAs).
- Understanding mortality patterns is crucial for comprehensive patient management.
Purpose of the Study:
- To evaluate the all-cause mortality risk in a large cohort of patients with hyperprolactinemia treated with dopamine agonists.
- To identify factors influencing mortality, including disease severity, treatment response, and comorbidities.
Main Methods:
- A nationwide retrospective cohort study (2000-2023) utilized the Clalit Health Services database.
- Patients with hyperprolactinemia treated with DAs were matched 1:5 with controls based on age, sex, BMI, and socioeconomic status.
- All-cause mortality was the primary outcome, with secondary analyses on prolactin normalization and baseline prolactin levels.
Main Results:
- No significant difference in all-cause mortality was observed between hyperprolactinemia patients (7.3%) and matched controls (7.5%) over a median follow-up of 17 years.
- Achieving prolactin normalization within one year was associated with reduced mortality (HR=0.730).
- Patients with baseline prolactin <5x ULN had lower mortality than those with ≥5x ULN. Mortality was higher in men than women with hyperprolactinemia.
Conclusions:
- Dopamine agonist-treated hyperprolactinemia does not confer an increased risk of all-cause mortality compared to matched controls.
- Mortality is significantly influenced by age, sex, BMI, and the presence of comorbidities.
- Early prolactin normalization is associated with improved survival outcomes in hyperprolactinemia patients.
Purpose:
Data on mortality risk in patients with hyperprolactinemia is limited. This study aimed to evaluate all-cause mortality in a cohort of dopamine agonist (DA)-treated patients with hyperprolactinemia.
Methods:
A nationwide retrospective study (2000-2023) using the Clalit Health Services database evaluated all-cause mortality in patients with DA-treated hyperprolactinemia, matched 1:5 with controls by age, sex, socioeconomic status, and BMI. The primary outcome was all-cause mortality. Secondary outcomes included the impact of hyperprolactinemia severity, prolactin (PRL) normalization, and other mortality risk factors.
Results:
The study included 2,492 patients with hyperprolactinemia (mean age ± SD:38.7 ± 14.8 years, 59.6% women) and 12,456 controls (38.7 ± 14.8 years, 59.6% women). Over > 17 years of follow-up, 182 patients (7.3%) and 936 controls (7.5%) died (HR = 0.972, 95% CI 0.829-1.139), with similar mean age at death. Causes of death in both groups were mainly infectious, cardiovascular, and malignancies. Compared to controls, patients achieving PRL normalization within 1 year had lower mortality (HR = 0.730), while those without normalization had similar risk. Patients with baseline PRL < 5×ULN had lower mortality (6.9% vs. 7.9%, HR = 0.725) than those with ≥ 5×ULN. Mortality was higher in men than in women with hyperprolactinemia but not versus controls. Independent predictors for all-cause mortality included older age, higher BMI, male sex, heart failure, malignancy, hypertension, diabetes, and ischemic heart disease.
Conclusion:
All-cause mortality in patients with DA-treated hyperprolactinemia is not increased compared to matched controls, however is higher in men vs. women. Mortality is primarily influenced by age, sex, BMI, and comorbidities. Achieving PRL normalization within a year decreases mortality compared with controls.
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