Crispo James A G, Farhat Nawal, Fortin Yannick, Perez-Lloret Santiago, Sikora Lindsey, Morgan Rebecca L, Habash Mara, Gogna Priyanka, Kelly Shannon E, Elliott Jesse, Kohen Dafna E, Bjerre Lise M, Mattison Donald R, Hessian Renée C, Willis Allison W, Krewski Daniel
McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1G 5Z3, Canada.
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Brain Sci. 2024 Jul 31;14(8):776. doi: 10.3390/brainsci14080776.
Reports suggest possible risks of adverse cardiovascular reactions, including heart failure, associated with non-ergot dopamine agonist (DA) use in Parkinson's disease (PD). The objectives of our review were to evaluate the risk of heart failure and other adverse cardiovascular reactions in PD patients who received a non-ergot DA compared with other anti-PD pharmacological interventions, placebo, or no intervention. Studies were identified via searches of six bibliographic databases. Randomized controlled trials (RCTs) and non-randomized studies (NRS) were eligible for study inclusion. Random-effect meta-analyses were performed to estimate adverse cardiovascular reaction risks. Quality of evidence was assessed using GRADE. In total, forty-four studies (thirty-six RCTs and eight NRS) satisfied our inclusion criteria. A single RCT found no significant difference in the risk of heart failure with ropinirole compared with bromocriptine (odds ratio (OR) 0.39, 95% confidence interval (CI) 0.07 to 2.04; low certainty). Conversely, three case-control studies reported a risk of heart failure with non-ergot DA treatment. The quality of evidence for the risk of heart failure was judged as low or very low. Findings suggest that non-ergot DA use may be associated with adverse cardiovascular outcomes, including heart failure. Studies are needed to better understand cardiovascular risks associated with PD treatment.
报告显示，在帕金森病（PD）患者中使用非麦角多巴胺激动剂（DA）可能存在不良心血管反应风险，包括心力衰竭。我们此次综述的目的是评估与其他抗帕金森病药物干预、安慰剂或不干预相比，接受非麦角DA治疗的帕金森病患者发生心力衰竭及其他不良心血管反应的风险。通过检索六个文献数据库来确定相关研究。随机对照试验（RCT）和非随机研究（NRS）均符合纳入标准。采用随机效应荟萃分析来估计不良心血管反应风险。使用GRADE评估证据质量。共有44项研究（36项RCT和8项NRS）符合我们的纳入标准。一项RCT发现，与溴隐亭相比，罗匹尼罗导致心力衰竭的风险无显著差异（优势比（OR）0.39，95%置信区间（CI）0.07至2.04；低确定性）。相反，三项病例对照研究报告了非麦角DA治疗存在心力衰竭风险。心力衰竭风险的证据质量被判定为低或极低。研究结果表明，使用非麦角DA可能与包括心力衰竭在内的不良心血管结局相关。需要开展更多研究以更好地了解与帕金森病治疗相关的心血管风险。
