Division of Endocrinology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
BMC Endocr Disord. 2020 Feb 19;20(1):25. doi: 10.1186/s12902-020-0507-8.
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.
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.
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.
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.
对于高泌乳素血症，使用较低剂量卡麦角林治疗是否会增加瓣膜功能障碍的风险仍存在争议。我们研究了接受多巴胺激动剂治疗的无症状高泌乳素血症成人中瓣膜异常的情况。
本横断面研究纳入了接受卡麦角林或溴隐亭治疗高泌乳素血症> 12 个月且无心脏相关症状的成年人。在研究就诊时，使用经胸超声心动图评估心脏瓣膜形态和功能（除了两名参与者），评估过程对所接受的多巴胺激动剂的类型和持续时间均设盲。
在 174 名参与者（平均年龄 49 ± 13 岁，63%为女性）中，在开始治疗前均无已知结构性心脏病，62 名参与者仅接受卡麦角林治疗，63 名参与者仅接受溴隐亭治疗，49 名参与者同时接受卡麦角林和溴隐亭治疗。仅接受卡麦角林治疗的参与者中位卡麦角林使用时间为 2.8 年，同时暴露于卡麦角林和溴隐亭的参与者中位卡麦角林使用时间为 3.2 年；仅接受溴隐亭治疗的参与者中位溴隐亭使用时间为 5.5 年，同时暴露于卡麦角林和溴隐亭的参与者中位溴隐亭使用时间为 1.1 年。与仅接受溴隐亭治疗的参与者（17.5%）相比，卡麦角林仅治疗组（37.1%，P=0.02）更常见≥1 个瓣膜反流，而同时暴露于卡麦角林和溴隐亭组（26.5%，P=0.26）则不然。与仅接受溴隐亭治疗的参与者（1.6%）相比，卡麦角林仅治疗组（11.3%，P=0.03）和同时暴露于卡麦角林和溴隐亭组（12.2%，P=0.04）更常见≥2 个瓣膜反流。与仅接受溴隐亭治疗的参与者相比，卡麦角林仅治疗组发生≥1 个瓣膜且反流程度为 2+级的调整后优势比（adjusted odds ratio，aOR）更高（aOR 3.2，95%置信区间 [confidence interval，CI]：1.3-7.5，P=0.008），但同时暴露于卡麦角林和溴隐亭的关联则不显著（aOR 1.7，95%CI：0.7-4.3，P=0.26）。与仅接受溴隐亭治疗的参与者相比，≥2 个瓣膜且反流程度为 2+级的调整后优势比（aOR）在卡麦角林仅治疗组（aOR 8.4，95%CI：1.0-72.2，P=0.05）和同时暴露于卡麦角林和溴隐亭组（aOR 8.8，95%CI：1.0-75.8，P=0.05）中更高。卡麦角林暴露量> 115mg 与≥2 个瓣膜且反流程度为 2+级的调整后优势比（aOR 9.6，95%CI：1.1-81.3，P=0.04）更高相关，而与仅接受溴隐亭治疗相比。
在接受高泌乳素血症治疗的社区成年人中，与溴隐亭相比，卡麦角林的使用和累积暴露量与主要为轻度瓣膜反流的发生率增加有关。需要研究明确哪些接受多巴胺激动剂治疗的患者可能受益于超声心动图筛查和监测。
