Screening for valve disease in patients with hyperprolactinaemia disorders prescribed cabergoline

a service evaluation and literature review

David Gamble, Rachel Fairley, Roderick Harvey, Colin Farman, Nathan Cantley, Stephen J Leslie

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVES:
The indication for screening for valvular heart disease in patients taking cabergoline is based on evidence from patients with Parkinson's disease on high-dose medication. However, current patients take much lower doses for indications such as hyperprolactinaemia disorders. Contemporary guidelines for echocardiogram monitoring in patients taking cabergoline are conflicting. This study aimed to review current clinical practice in our area regarding echocardiographic screening and to review the literature examining the evidence of valvular heart disease in patients taking lower dose cabergoline.

METHODS:
This was a retrospective study of all patients with hyperprolactinaemia disorders prescribed cabergoline in a single UK NHS health board between January 2014 and July 2015. The proportion of patients receiving baseline and follow-up echocardiograms was recorded. A review of the published literature was carried out using the databases EMBASE and Medline to examine the current evidence for the effect cabergoline has on cardiac valves in patients treated for hyperprolactinaemia disorders.

RESULTS:
The mean age was 51.7 ± 16.5 years with a 64.4% female predominance. The mean duration of therapy was 5.9 years ± 4.1 years. Of the total cohort (n = 45), two (4.4%) patients had an initial baseline echocardiogram and five (13.2%) had follow-up echocardiograms every 24 months. Of the 25 articles identified, 12 showed no clinically significant evidence of valvular dysfunction in the cabergoline group groups. Of the remaining 13 articles, evidence for valvular changes was confined to high cumulative dose cabergoline patients and there was only one confirmed case of 'cabergoline associated valvulopathy' described.

CONCLUSIONS:
Clinically significant valvular dysfunction is uncommon and generally only reported in high cumulative dose treatment groups. We propose that clearer national guidelines are required and that echocardiogram screening be reserved for patients who are high risk, are taking a high weekly dose (≥2 mg cabergoline weekly) or high cumulative dose.
Original languageEnglish
Pages (from-to)215-229
Number of pages15
JournalTherapeutic Advances in Drug Safety
Volume8
Issue number7
Early online date25 Apr 2017
DOIs
Publication statusPublished - 1 Jul 2017

Fingerprint

Hyperprolactinemia
Heart Valve Diseases
cabergoline
Guidelines
Heart Valves
Physiologic Monitoring
Risk-Taking
Parkinson Disease
Retrospective Studies
Databases

Keywords

  • cabergoline
  • cardiac valve disease
  • echocardiography surveillance

Cite this

Screening for valve disease in patients with hyperprolactinaemia disorders prescribed cabergoline : a service evaluation and literature review. / Gamble, David; Fairley, Rachel ; Harvey, Roderick; Farman, Colin; Cantley, Nathan; Leslie, Stephen J.

In: Therapeutic Advances in Drug Safety, Vol. 8, No. 7, 01.07.2017, p. 215-229.

Research output: Contribution to journalArticle

Gamble, David ; Fairley, Rachel ; Harvey, Roderick ; Farman, Colin ; Cantley, Nathan ; Leslie, Stephen J. / Screening for valve disease in patients with hyperprolactinaemia disorders prescribed cabergoline : a service evaluation and literature review. In: Therapeutic Advances in Drug Safety. 2017 ; Vol. 8, No. 7. pp. 215-229.
@article{e06296523aa34da9a5b470a5825bc88a,
title = "Screening for valve disease in patients with hyperprolactinaemia disorders prescribed cabergoline: a service evaluation and literature review",
abstract = "OBJECTIVES:The indication for screening for valvular heart disease in patients taking cabergoline is based on evidence from patients with Parkinson's disease on high-dose medication. However, current patients take much lower doses for indications such as hyperprolactinaemia disorders. Contemporary guidelines for echocardiogram monitoring in patients taking cabergoline are conflicting. This study aimed to review current clinical practice in our area regarding echocardiographic screening and to review the literature examining the evidence of valvular heart disease in patients taking lower dose cabergoline.METHODS:This was a retrospective study of all patients with hyperprolactinaemia disorders prescribed cabergoline in a single UK NHS health board between January 2014 and July 2015. The proportion of patients receiving baseline and follow-up echocardiograms was recorded. A review of the published literature was carried out using the databases EMBASE and Medline to examine the current evidence for the effect cabergoline has on cardiac valves in patients treated for hyperprolactinaemia disorders.RESULTS:The mean age was 51.7 ± 16.5 years with a 64.4{\%} female predominance. The mean duration of therapy was 5.9 years ± 4.1 years. Of the total cohort (n = 45), two (4.4{\%}) patients had an initial baseline echocardiogram and five (13.2{\%}) had follow-up echocardiograms every 24 months. Of the 25 articles identified, 12 showed no clinically significant evidence of valvular dysfunction in the cabergoline group groups. Of the remaining 13 articles, evidence for valvular changes was confined to high cumulative dose cabergoline patients and there was only one confirmed case of 'cabergoline associated valvulopathy' described.CONCLUSIONS:Clinically significant valvular dysfunction is uncommon and generally only reported in high cumulative dose treatment groups. We propose that clearer national guidelines are required and that echocardiogram screening be reserved for patients who are high risk, are taking a high weekly dose (≥2 mg cabergoline weekly) or high cumulative dose.",
keywords = "cabergoline, cardiac valve disease, echocardiography surveillance",
author = "David Gamble and Rachel Fairley and Roderick Harvey and Colin Farman and Nathan Cantley and Leslie, {Stephen J}",
year = "2017",
month = "7",
day = "1",
doi = "10.1177/2042098617703647",
language = "English",
volume = "8",
pages = "215--229",
journal = "Therapeutic Advances in Drug Safety",
issn = "2042-0986",
publisher = "SAGE Publications Ltd",
number = "7",

}

TY - JOUR

T1 - Screening for valve disease in patients with hyperprolactinaemia disorders prescribed cabergoline

T2 - a service evaluation and literature review

AU - Gamble, David

AU - Fairley, Rachel

AU - Harvey, Roderick

AU - Farman, Colin

AU - Cantley, Nathan

AU - Leslie, Stephen J

PY - 2017/7/1

Y1 - 2017/7/1

N2 - OBJECTIVES:The indication for screening for valvular heart disease in patients taking cabergoline is based on evidence from patients with Parkinson's disease on high-dose medication. However, current patients take much lower doses for indications such as hyperprolactinaemia disorders. Contemporary guidelines for echocardiogram monitoring in patients taking cabergoline are conflicting. This study aimed to review current clinical practice in our area regarding echocardiographic screening and to review the literature examining the evidence of valvular heart disease in patients taking lower dose cabergoline.METHODS:This was a retrospective study of all patients with hyperprolactinaemia disorders prescribed cabergoline in a single UK NHS health board between January 2014 and July 2015. The proportion of patients receiving baseline and follow-up echocardiograms was recorded. A review of the published literature was carried out using the databases EMBASE and Medline to examine the current evidence for the effect cabergoline has on cardiac valves in patients treated for hyperprolactinaemia disorders.RESULTS:The mean age was 51.7 ± 16.5 years with a 64.4% female predominance. The mean duration of therapy was 5.9 years ± 4.1 years. Of the total cohort (n = 45), two (4.4%) patients had an initial baseline echocardiogram and five (13.2%) had follow-up echocardiograms every 24 months. Of the 25 articles identified, 12 showed no clinically significant evidence of valvular dysfunction in the cabergoline group groups. Of the remaining 13 articles, evidence for valvular changes was confined to high cumulative dose cabergoline patients and there was only one confirmed case of 'cabergoline associated valvulopathy' described.CONCLUSIONS:Clinically significant valvular dysfunction is uncommon and generally only reported in high cumulative dose treatment groups. We propose that clearer national guidelines are required and that echocardiogram screening be reserved for patients who are high risk, are taking a high weekly dose (≥2 mg cabergoline weekly) or high cumulative dose.

AB - OBJECTIVES:The indication for screening for valvular heart disease in patients taking cabergoline is based on evidence from patients with Parkinson's disease on high-dose medication. However, current patients take much lower doses for indications such as hyperprolactinaemia disorders. Contemporary guidelines for echocardiogram monitoring in patients taking cabergoline are conflicting. This study aimed to review current clinical practice in our area regarding echocardiographic screening and to review the literature examining the evidence of valvular heart disease in patients taking lower dose cabergoline.METHODS:This was a retrospective study of all patients with hyperprolactinaemia disorders prescribed cabergoline in a single UK NHS health board between January 2014 and July 2015. The proportion of patients receiving baseline and follow-up echocardiograms was recorded. A review of the published literature was carried out using the databases EMBASE and Medline to examine the current evidence for the effect cabergoline has on cardiac valves in patients treated for hyperprolactinaemia disorders.RESULTS:The mean age was 51.7 ± 16.5 years with a 64.4% female predominance. The mean duration of therapy was 5.9 years ± 4.1 years. Of the total cohort (n = 45), two (4.4%) patients had an initial baseline echocardiogram and five (13.2%) had follow-up echocardiograms every 24 months. Of the 25 articles identified, 12 showed no clinically significant evidence of valvular dysfunction in the cabergoline group groups. Of the remaining 13 articles, evidence for valvular changes was confined to high cumulative dose cabergoline patients and there was only one confirmed case of 'cabergoline associated valvulopathy' described.CONCLUSIONS:Clinically significant valvular dysfunction is uncommon and generally only reported in high cumulative dose treatment groups. We propose that clearer national guidelines are required and that echocardiogram screening be reserved for patients who are high risk, are taking a high weekly dose (≥2 mg cabergoline weekly) or high cumulative dose.

KW - cabergoline

KW - cardiac valve disease

KW - echocardiography surveillance

U2 - 10.1177/2042098617703647

DO - 10.1177/2042098617703647

M3 - Article

VL - 8

SP - 215

EP - 229

JO - Therapeutic Advances in Drug Safety

JF - Therapeutic Advances in Drug Safety

SN - 2042-0986

IS - 7

ER -