Publication related to RSI or an RSI staff member
Associations Between Cardiovascular Events and Nonergot Dopamine Agonists in Parkinson’s Disease.
BACKGROUND: Knowledge of possible cardiovascular risks from Parkinson’s disease (PD) medications is critical to informing safe and effective treatment decisions. The objective of our study was to determine whether PD patients treated with nonergot dopamine agonists (DAs) are at increased risk of adverse cardiovascular or cerebrovascular outcomes, relative to PD patients receiving other treatments. METHODS: Matched case-control studies were conducted within a cohort of 14,122 inpatients receiving treatment for PD who were identified in the Cerner Health Facts database. Primary outcomes were associations between nonergot DA use and diagnosis of adverse cardiovascular events (acute myocardial infarction, heart failure [HF], hypotension, and valvulopathy). Secondary outcomes included associations between nonergot DA use and diagnosis of adverse cerebrovascular events (cerebrovascular accident and ischemic stroke) and odds of significant exposure-outcome relationships by patient factors. RESULTS: HF was the only adverse event that demonstrated a significant association with nonergot DA use. Individuals treated with pramipexole were more likely to be diagnosed with HF, relative to no use (adjusted odds ratio [AOR]: 1.28; 95% confidence interval [CI]: 1.07-1.53). The association between pramipexole and HF was greater among individuals treated with pramipexole monotherapy (relative to levodopa monotherapy) (AOR, 1.50; 95% CI: 1.09-2.06). Compared to nonusers, men and older individuals treated with pramipexole were more likely to be diagnosed with HF. CONCLUSIONS: Results from our study suggest an association between pramipexole use and HF. Findings warrant replication; however, individuals with PD and independent risk factors for, or a history of, HF may benefit from limited use of this drug.
Authors
- Crispo, James A G, Crispo JAG, McLaughlin Center for Population Health Risk Assessment University of Ottawa Ottawa Ontario Canada.; Fulbright Canada Student University of Pennsylvania Philadelphia Pennsylvania USA.
- Willis, Allison W, Willis AW, Departments of Neurology and Biostatistics & Epidemiology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA.
- Thibault, Dylan P, Thibault DP, Departments of Neurology and Biostatistics & Epidemiology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA.
- Fortin, Yannick, Fortin Y, McLaughlin Center for Population Health Risk Assessment University of Ottawa Ottawa Ontario Canada.
- Emons, Matthew, Emons M, Cerner Corporation Culver City California USA.
- Bjerre, Lise M, Bjerre LM, Department of Family Medicine University of Ottawa Ottawa Ontario Canada.; C.T. Lamont Primary Health Care Research Center Bruyère Research Institute Ottawa Ontario Canada.; School of Epidemiology, Public Health and Preventive Medicine University of Ottawa Ottawa Ontario Canada.
- Kohen, Dafna E, Kohen DE, School of Epidemiology, Public Health and Preventive Medicine University of Ottawa Ottawa Ontario Canada.
- Perez-Lloret, Santiago, Perez-Lloret S, Institute for Cardiology Research (ININCA) National Research Council (CONICET) Buenos Aires Argentina.
- Mattison, Donald, Mattison D, McLaughlin Center for Population Health Risk Assessment University of Ottawa Ottawa Ontario Canada.; Risk Sciences International Ottawa Ontario Canada.
- Krewski, Daniel, Krewski D, McLaughlin Center for Population Health Risk Assessment University of Ottawa Ottawa Ontario Canada.; Risk Sciences International Ottawa Ontario Canada.
BACKGROUND: Knowledge of possible cardiovascular risks from Parkinson's disease (PD) medications is critical to informing safe and effective treatment decisions. The objective of our study was to determine whether PD patients treated with nonergot dopamine agonists (DAs) are at increased risk of adverse cardiovascular or cerebrovascular outcomes, relative to PD patients receiving other treatments. METHODS: Matched case-control studies were conducted within a cohort of 14,122 inpatients receiving treatment for PD who were identified in the Cerner Health Facts database. Primary outcomes were associations between nonergot DA use and diagnosis of adverse cardiovascular events (acute myocardial infarction, heart failure [HF], hypotension, and valvulopathy). Secondary outcomes included associations between nonergot DA use and diagnosis of adverse cerebrovascular events (cerebrovascular accident and ischemic stroke) and odds of significant exposure-outcome relationships by patient factors. RESULTS: HF was the only adverse event that demonstrated a significant association with nonergot DA use. Individuals treated with pramipexole were more likely to be diagnosed with HF, relative to no use (adjusted odds ratio [AOR]: 1.28; 95% confidence interval [CI]: 1.07-1.53). The association between pramipexole and HF was greater among individuals treated with pramipexole monotherapy (relative to levodopa monotherapy) (AOR, 1.50; 95% CI: 1.09-2.06). Compared to nonusers, men and older individuals treated with pramipexole were more likely to be diagnosed with HF. CONCLUSIONS: Results from our study suggest an association between pramipexole use and HF. Findings warrant replication; however, individuals with PD and independent risk factors for, or a history of, HF may benefit from limited use of this drug.
