Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark.
BMC Cardiovasc Disord. 2021 Dec 28;21(1):622. doi: 10.1186/s12872-021-02439-y.
Ergot-derived dopamine agonists are thought to induce fibrotic changes in cardiac valve leaflets. We sought to determine the incidence of heart valve disease in women treated with bromocriptine compared with age and sex matched controls from the background population.
In nationwide Danish registries we identified female patients treated with bromocriptine in the period 1995-2018. Patients were included at date of second redeemed prescription and were matched 1:5 with controls from the background population based on age, sex and year of inclusion by use of incidence density sampling. The outcomes were hospital admission for or outpatient diagnosis of heart valve disease, and death as competing risk. Incidence rates, cumulative incidence curves, and adjusted cox-proportional hazard models adjusted for cardiovascular risk factors were used to assess outcomes in bromocriptine users versus controls.
A total of 3035 female bromocriptine users and 15,175 matched controls were included. Median age at inclusion was 32 years (Q1-Q3, 28-37 years). Both bromocriptine users and controls had few comorbidities and low use of concomitant pharmacotherapy. Within 10 years of follow-up, 11 patients (0.34%, 95% CI 0.13-0.55%) and 44 controls (0.29%, 95% CI 0.20-0.37) met the primary endpoint of heart valve disease, p = 0.63. The adjusted cox regression analysis yielded a hazard ratio of 0.96 (95% confidence interval (CI) 0.55-1.69, p = 0.89).
Treatment initiation with ergot-derived dopamine agonist bromocriptine in younger women with few comorbidities, was associated with a low absolute long-term risk of heart valve disease, not significantly different from the risk in age and sex matched population controls. Thus, indicating a low clinical yield of pre-treatment echocardiographic screening in this patient population in accordance with current guidelines.
人们认为，源自麦角的多巴胺激动剂会引起心脏瓣膜叶的纤维性变化。我们试图确定与背景人群中年龄和性别匹配的对照组相比，接受溴隐亭治疗的女性发生心脏瓣膜病的发生率。
在全国性的丹麦登记处，我们确定了 1995 年至 2018 年期间接受溴隐亭治疗的女性患者。患者在第二次处方配药时被纳入，并通过发病率密度抽样，根据年龄、性别和纳入年份与背景人群中的 5 名对照进行 1:5 匹配。结果是因心脏瓣膜病住院或门诊诊断，以及作为竞争风险的死亡。使用接受溴隐亭治疗的患者与对照组的发生率、累积发生率曲线和调整心血管危险因素的 Cox 比例风险模型来评估结果。
共纳入 3035 名女性溴隐亭使用者和 15175 名匹配对照。纳入时的中位年龄为 32 岁（四分位距 28-37 岁）。溴隐亭使用者和对照组的合并症均较少，同时使用的药物治疗也较少。在 10 年的随访期间，11 名患者（0.34%，95%置信区间 0.13-0.55%）和 44 名对照（0.29%，95%置信区间 0.20-0.37）达到了心脏瓣膜病的主要终点，p=0.63。调整后的 Cox 回归分析得出危险比为 0.96（95%置信区间 0.55-1.69，p=0.89）。
在合并症较少的年轻女性中开始使用源自麦角的多巴胺激动剂溴隐亭治疗，与年龄和性别匹配的对照组相比，发生心脏瓣膜病的绝对长期风险较低，差异无统计学意义。因此，这表明与当前指南一致，在该患者人群中，治疗前进行超声心动图筛查的临床收益较低。
