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Pergolide Associated Cardiac Valvulopathy Based on Ontario Administrative Data

Published online by Cambridge University Press:  02 December 2014

Cindy Zadikoff ,
Minh Duong-Hua ,
Kathy Sykora ,
Connie Marras ,
Anthony Lang  and
Paula Rochon
Cindy Zadikoff
Affiliation:
Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Department of Neurology Parkinson’s Disease and Movement Disorders Center, Northwestern University, Chicago, USA
Minh Duong-Hua
Affiliation:
Institute for Clinical Evaluative Sciences
Kathy Sykora
Affiliation:
Institute for Clinical Evaluative Sciences
Connie Marras
Affiliation:
Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Department of Neurology
Anthony Lang
Affiliation:
Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Department of Neurology
Paula Rochon
Affiliation:
Institute for Clinical Evaluative Sciences Kunin Lunenfeld Applied Research Unit, (KLARU), Toronto, Ontario, Canada
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Abstract

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Introduction:

Pergolide is an ergot derived dopamine agonist that is widely used for the treatment of Parkinson’s disease. Studies have found an association between pergolide and valvular heart abnormalities although there is still much to be learned about the clinical significance of the valvular changes, who is at risk, and whether there is duration of exposure effect.

Objective:

To assess the long term risk of hospital admissions for valvular heart disease (VHD) or congestive heart failure (CHF, a clinically overt outcome of VHD) in new users of pergolide compared to new users of levodopa. The secondary objective was to assess whether there are any characteristics that can predict who is at higher risk of developing this outcome.

Design:

Retrospective, population-based cohort study.

Setting:

Ontario, Canada.

Subjects:

Ontario residents aged 66 and older, newly started on treatment with either pergolide or levodopa.

Outcomes:

Admission to hospital with the most responsible diagnosis of congestive heart failure or valvular heart disease.

Results:

The risk for admission for valvular heart disease or congestive heart failure were higher in those with 1-4 years exposure to pergolide compared with no exposure to pergolide (VHD: hazard ratio 2.4, p = 0.04; CHF: hazard ratio 1.6, p =0.02). No such pattern was found with exposure to levodopa.

Conclusion:

Our study demonstrates that treatment with pergolide is associated with a higher risk of hospital admission for valvular heart disease or congestive heart failure and that this risk is greater in those with 1-4 years exposure than in those with less exposure. We did not find an increased risk beyond four years.

Résumé:

<span class='bold'>RÉSUMÉ:</span><span class='bold'><span class='italic'>Contexte:</span></span>

Le pergolide est un agoniste de la dopamine qui est dérivé de l’ergot. Il est couramment utilisé dans le traitement de la maladie de Parkinson. Des études ont mis en évidence une association entre le pergolide et des anomalies valvulaires cardiaques. Cependant on ne connaît pas la signification clinique des changements valvulaires, quels patients sont à risque et si la durée d’exposition a un effet

<span class='bold'><span class='italic'>Objectif:</span></span>

Le but de cette étude était d’évaluer le risque à long terme d’hospitalisation pour maladie cardiaque valvulaire (MCV) ou insuffisance cardiaque congestive (ICC, une conséquence clinique de la MCV) chez des patients qui prennent du pergolide depuis peu et chez des patients qui prennent de la lévodopa depuis peu. L’objectif secondaire était d’évaluer s’il existe des caractéristiques qui pourraient prédire qui est à plus haut risque de MCV.

<span class='bold'><span class='italic'>Plan d’étude</span></span>

Il s’agit d’une étude rétrospective de cohorte tirée de la population.

<span class='bold'><span class='italic'>Cadre:</span></span>

Cette étude a été effectuée en Ontario, au Canada.

<span class='bold'><span class='italic'>Sujets:</span></span>

Nous avons examiné les données de résidents de l’Ontario, ages de 66 ans et plus, qui prenaient du pergolide ou de la lévodopa depuis peu

<span class='bold'><span class='italic'>Critères d’évaluation:</span></span>

Un diagnostic d#x2019;ICC ou de MCV comme motif principal d#x2019;hospitalisation. Résultats : Le risque d#x2019;admission pour MCV ou ICC était plus élevé chez ceux qui avaient été exposés pendant 1 à 4 ans au pergolide par rapport à ceux qui n#x2019;y avaient pas été exposés (MCV ; rapport de risques 2,4 p = 0,04; ICC : rapport de risques 1,6 p = 0,02), ce qui n#x2019;était pas le cas pour la lévodopa.

<span class='bold'><span class='italic'>Conclusion:</span></span>

Cette étude démontre que le traitement par le pergolide est associé à un risque plus élevé d#x2019;hospitalisation pour MCV ou ICC et que ce risque est plus élevé chez ceux qui y ont été exposés pendant 1 à 4 ans que chez ceux dont la durée d#x2019;exposition est moindre. Le risque n#x2019;augmentait pas davantage si la durée d#x2019;exposition était de plus de 4 ans.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 2 , May 2008 , pp. 173 - 178
Copyright
Copyright © The Canadian Journal of Neurological 2008

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