Recently the possible correlation between dopamine agonists and valvular heart disease has been raised in a few conferences. Originally brought on by a recent article in NEJM by Zanettini et al in 2007 that looked at 11, 417 subjects who were prescribed anti-parkinsonian drugs and matched each case of valvular disease to 25 controls. Noted 31 cases of valvular diease and out of these 6 were given cabergoline, 6 pergolide, and 19 were not exposed to dopamine agonists. The rate of cardiac-valve regurgitation was increased with current use of pergolide (incidence-rate ratio, 7.1; 95% confidence interval [CI], 2.3 to 22.3) and cabergoline (incidence-rate ratio, 4.9; 95% CI, 1.5 to 15.6), but not with current use of other dopamine agonists.
Because of this higher incidence with cabergoline and pergolide as opposed to other dopamine agonists, the question is raised as to whether this is applicable to prolactinoma treatment in which we use much lower dosages of these agents.
To answer this Devin et al (Endocrine Practice Sept 2008) conducted a recent retrospective review of patients identified with hyperprolactinemia who underwent elective echocardiography. They noted valvular disease in 7% of cases (no different than the general population) and much less than close to 30% found in other studies.
Big differences were the mean dose of cabergoline was 0.91+/- 0.96mg per week, whereas the anti-parkinsonian doses may be as high as 3mg/d.
are there any guidelines that recommend a routine echo prior to the use of cabergoline?
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