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Cardiac valvular abnormalities associated with use and cumulative exposure of cabergoline for hyperprolactinemia: the CATCH study.
BMC Endocrine Disorders ( IF 2.7 ) Pub Date : 2020-02-19 , DOI: 10.1186/s12902-020-0507-8
Amer Budayr 1 , Thida C Tan 2 , Joan C Lo 1, 2 , Jonathan G Zaroff 2, 3 , Grace H Tabada 2 , Jingrong Yang 2 , Alan S Go 2, 4, 5
Affiliation  

BACKGROUND Whether lower dose cabergoline therapy for hyperprolactinemia increases risk of valvular dysfunction remains controversial. We examined valvular abnormalities among asymptomatic adults with hyperprolactinemia treated with dopamine agonists. METHODS This cross-sectional study was conducted among adults receiving cabergoline or bromocriptine for > 12 months for hyperprolactinemia and had no cardiac-related symptoms. Cardiac valve morphology and function were assessed from transthoracic echocardiograms at the study visit (except for two participants) with evaluation performed blinded to type and duration of dopamine agonist received. RESULTS Among 174 participants (mean age 49 ± 13 years, 63% women) without known structural heart disease before starting therapy, 62 received only cabergoline, 63 received only bromocriptine, and 49 received both. Median cabergoline use was 2.8 years in cabergoline only users and 3.2 years for those exposed to both cabergoline and bromocriptine; median bromocriptine use was 5.5 years in bromocriptine only users and 1.1 years for those exposed to both cabergoline and bromocriptine. Compared with bromocriptine only users (17.5%), regurgitation of ≥1 valve was more common for cabergoline only (37.1%, P = 0.02) but not for combined exposure (26.5%, P = 0.26). Compared with bromocriptine only exposure (1.6%), regurgitation of ≥2 valves was more common for cabergoline only (11.3%, P = 0.03) and combined exposure (12.2%, P = 0.04). Cabergoline only users had higher age-sex-adjusted odds for ≥1 valve with grade 2+ regurgitation compared to bromocriptine only users (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI]:1.3-7.5, P = 0.008), but the association for combined exposure to cabergoline and bromocriptine was not significant (aOR 1.7, 95%CI:0.7-4.3, P = 0.26). Compared to bromocriptine only, age-sex-adjusted odds of ≥2 valves with grade 2+ regurgitation were higher for both cabergoline only (aOR 8.4, 95% CI:1.0-72.2, P = 0.05) and combined exposure (aOR 8.8, 95% CI:1.0-75.8, P = 0.05). Cumulative cabergoline exposure > 115 mg was associated with a higher age-sex adjusted odds of ≥2 valves with grade 2+ regurgitation (aOR 9.6, 95%CI:1.1-81.3, P = 0.04) compared to bromocriptine only. CONCLUSIONS Among community-based adults treated for hyperprolactinemia, cabergoline use and greater cumulative cabergoline exposure were associated with a higher prevalence of primarily mild valvular regurgitation compared with bromocriptine. Research is needed to clarify which patients treated with dopamine agonists may benefit from echocardiographic screening and surveillance.

中文翻译:

卡麦角林在高催乳素血症中的使用和累积暴露与心脏瓣膜异常:CATCH研究。

背景技术用于高泌乳素血症的低剂量卡麦角林疗法是否会增加瓣膜功能障碍的风险仍存在争议。我们检查了多巴胺激动剂治疗的无催乳激素血症的无症状成年人的瓣膜异常。方法这项横断面研究是在接受卡麦角林或溴隐亭治疗≥12个月的高泌乳素血症且没有心脏相关症状的成年人中进行的。在研究访问时(两个参与者除外)通过经胸超声心动图评估了心脏瓣膜的形态和功能,并且对所接受的多巴胺激动剂的类型和持续时间不了解。结果在开始治疗前无已知结构性心脏病的174名参与者(平均年龄49±13岁,女性占63%)中,62名仅接受卡麦角林,63名仅接受溴隐亭,和49都收到了。仅使用卡麦角林的用户中卡麦角林的中位使用时间为2.8年,同时接触卡麦角林和溴隐亭的用户中位使用时间为3.2年;仅使用溴隐亭的使用者中位溴隐亭的中位使用期为5.5年,同时接受卡麦角林和溴隐亭的使用者中位使用期为1.1年。与仅使用溴隐亭的使用者(17.5%)相比,仅卡麦角林(≥37.1%,P = 0.02)≥1个瓣膜反流更为常见,而合并暴露量则为(26.5%,P = 0.26)。与仅溴隐亭暴露(1.6%)相比,仅卡麦角林(11.3%,P = 0.03)和联合暴露(12.2%,P = 0.04)≥2个瓣膜反流更为常见。与仅使用溴隐亭的用户相比,仅使用卡麦角林的用户对≥1瓣2级以上反流的年龄性别调整后的机率更高(调整后的机率比[aOR] 3.2,95%置信区间[CI]:1.3-7.5,P = 0。008),但联合使用卡麦角林和溴隐亭的关联性不显着(aOR 1.7,95%CI:0.7-4.3,P = 0.26)。与仅溴隐亭相比,仅使用卡麦角林(aOR 8.4,95%CI:1.0-72.2,P = 0.05)和联合暴露(aOR 8.8,95)时,年龄≥2瓣反流的经年龄性别调整的几率都更高%CI:1.0-75.8,P = 0.05)。与仅使用溴隐亭相比,累积的卡麦角林暴露量> 115 mg与2级以上返流的经年龄性别调整的可能性更高,≥2个瓣膜(aOR 9.6,95%CI:1.1-81.3,P = 0.04)。结论在接受高泌乳素血症治疗的以社区为基础的成年人中,卡麦角林的使用和卡麦角林的累积暴露量较高,与溴隐亭相比,轻度瓣膜返流的患病率更高。
更新日期:2020-04-22
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