Association Between Ergot-Derived Dopamine Agonists and Valvular Heart Disease: A Systematic Review and Meta-Analysis

Dopamine agonists (DAs) have been linked to valvular heart disease (VHD). Literature suggests worsening valvular regurgitation with usage of these drugs, although some reports have found no significant association. This systematic review and meta-analysis aimed to determine whether treatment with ergot-derived DAs is associated with an increased incidence of VHD or worsening of preexisting valvular regurgitation. A systematic review and meta-analysis was conducted by synthesising data from multiple observational studies and clinical trials, focusing on the effects of both ergot-derived and non-ergot DAs on the development of VHD. Inclusion criteria were patients diagnosed with Parkinson disease or hyperprolactinaemia treated with DAs. Baseline patient characteristics including sex, ethnicity, cardiovascular risk factors, dosage, and duration of treatment were evaluated. Pooled risk estimates were calculated using random-effects models. Among 47,270 patients from 33 observational studies, those on ergot-derived DAs had a higher rate of developing VHD (4.0% vs 1.1% in non-ergot DA users or controls). The pooled risk ratio of VHD was significantly elevated in patients treated with pergolide [risk ratios (RR) 2.29, 95% confidence interval (CI): 1.62-3.24], cabergoline (RR 1.68, 95% CI: 1.21-2.34), and bromocriptine (RR 1.52, 95% CI: 1.02-2.27). Compared to controls, ergot-derived DAs were associated with an increased risk for aortic (RR 2.75, 95% CI: 1.81-4.20), mitral (RR 1.70, 95% CI: 1.23-2.36), and tricuspid (RR 1.54, 95% CI: 1.08-2.20) regurgitation. Ergot-derived DAs are significantly associated with an increased risk of VHD. Close echocardiographic monitoring should be emphasised for patients receiving ergot-derived DAs, particularly those on long-term or high-dose therapy.