Queen Mary University of London, London, UK.
Department of Endocrinology, Saint Bartholomew's Hospital, London, UK.
J Clin Endocrinol Metab. 2021 Jan 23;106(2):e711-e720. doi: 10.1210/clinem/dgaa882.
Controversy exists as to whether low-dose cabergoline is associated with clinically significant valvulopathy. Few studies examine hard cardiac endpoint data, most relying on echocardiographic findings.
To determine the prevalence of valve surgery or heart failure in patients taking cabergoline for prolactinoma against a matched nonexposed population.
Population-based cohort study based on North East London primary care records.
Data were drawn from ~1.5 million patients' primary care records. We identified 646 patients taking cabergoline for >6 months for prolactinoma. These were matched to up to 5 control individuals matched for age, gender, ethnicity, location, diabetes, hypertension, ischemic heart disease, and smoking status. Cumulative doses/durations of treatment were calculated. Cardiac endpoints were defined as cardiac valve surgery or heart failure diagnosis (either diagnostic code or prescription code for associated medications).
A total of 18 (2.8%) cabergoline-treated patients and 62 (2.33%) controls reached a cardiac endpoint. Median cumulative cabergoline dose was 56 mg (interquartile range [IQR] 27-123). Median treatment duration was 27 months (IQR 15-46). Median weekly dose was 2.1 mg. Neither univariate nor multivariate analysis demonstrated a significant association between cabergoline treatment at any cumulative dosage/duration and an increased incidence of cardiac endpoints. In a matched analysis, the relative risk for cardiac complications in the cabergoline-treated group was 0.78 (95% CI, 0.41-1.48; P = 0.446). Reanalysis of echocardiograms for 6/18 affected cabergoline-treated patients showed no evidence of ergot-derived drug valvulopathy.
The data did not support an association between clinically significant valvulopathy and low-dose cabergoline treatment and provide further evidence for a reduction in frequency of surveillance echocardiography.
小剂量卡麦角林是否与临床显著的瓣膜病有关，存在争议。很少有研究检查硬终点心脏数据，大多数依赖于超声心动图发现。
确定服用卡麦角林治疗催乳素瘤的患者与未暴露人群相比，瓣膜手术或心力衰竭的患病率。
基于英国伦敦东北部初级保健记录的基于人群的队列研究。
数据来自约 150 万患者的初级保健记录。我们确定了 646 名接受卡麦角林治疗>6 个月的催乳素瘤患者。这些患者与年龄、性别、种族、位置、糖尿病、高血压、缺血性心脏病和吸烟状况相匹配的多达 5 名对照个体相匹配。计算了累积剂量/治疗时间。心脏终点定义为心脏瓣膜手术或心力衰竭诊断（诊断代码或相关药物的处方代码）。
共有 18 名（2.8%）卡麦角林治疗患者和 62 名（2.33%）对照组患者达到心脏终点。卡麦角林累积剂量中位数为 56 毫克（四分位距[IQR] 27-123）。中位治疗时间为 27 个月（IQR 15-46）。每周中位剂量为 2.1 毫克。无论是单变量还是多变量分析均未显示卡麦角林治疗累积剂量/时间与心脏终点发生率增加之间存在显著关联。在匹配分析中，卡麦角林治疗组心脏并发症的相对风险为 0.78（95%CI，0.41-1.48；P=0.446）。对 18 名受影响的卡麦角林治疗患者中的 6 名进行的超声心动图重新分析显示，没有证据表明与麦角衍生药物瓣膜病有关。
数据不支持临床显著瓣膜病与小剂量卡麦角林治疗之间存在关联，并为减少常规超声心动图检查的频率提供了进一步证据。
