Cardiac valvular abnormalities associated with use and cumulative exposure of cabergoline for hyperprolactinemia: the CATCH study

Abstract

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.

Adjuvant combined therapy with trastuzumab in patients with HER2-positive breast cancer and cardiac alterations: implications for optimal cardio-oncology care

“…Moreover, it affects heart muscle contraction and relaxation, influences the conduction system, and induces arrhythmia [10][11][12][13][14]. It was postulated that cardiac fibrosis may be caused by the use of certain drugs or by some conditions such as HA, myocardial infarction, inflammation, or aging [15][16][17]. In our study, valvular fibrosis was diagnosed during or after TT in 28.4% of patients with HER2-positive BC who received trastuzumab as well as chemotherapy and radiotherapy in the adjuvant setting.…”

Outcomes of Transsphenoidal Microsurgery for Prolactinomas – A Contemporary Series of 162 Cases

“…In this study, median CAB-only use was 2.8 years and median BC-only use was 5.5 years. CAB users had a higher age-sex-adjusted odds ratio for ≥ 1 valve grade 2 + regurgitation compared to BConly users (adjusted odds ratio 3.2, 95 % confidence interval: 1.3 − 7.5, p = 0.008) [14]. A limitation of the study is the missing control group.…”

“…A systematic review on prolactinoma patients that defined CAB-associated valvulopathy by the triad of moderate or severe regurgitation associated with a restricted and thickened valve identified two (0.11 %) of 1811 patients with confirmed CABassociated valvulopathy [13]. The cross-sectional CATCH study of 2020 examined valvular abnormalities with use of CAB or BC for hyperprolactinaemia in patients without cardiac-related symptoms [14]. In this study, median CAB-only use was 2.8 years and median BC-only use was 5.5 years.…”

(Cardiovascular complications in acromegaly)

“…Niektoré štúdie potvrdili zvýšenú prevalenciu ľahkej valvulárnej regurgitácie pri dlhodobom podávaní kabergolínu (kumulatívny efekt). 73 Na posúdenie vplyvu rádioterapie na kardiovaskulárny systém u pacientov s akromegáliou nie je doposiaľ realizované dostatočné množstvo štúdií. Môže to byť spôsobené oneskoreným efektom liečby ako aj sprievodným rizikom hypopituarizmu, ktoré neumožňuje spoľahlivú analýzu jeho priaznivých vplyvov na kardiovaskulárne riziko.…”