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Dopamine agonist use and the risk of heart failure

Authors

  • Christel Renoux,

    1. Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada
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  • Sophie Dell'Aniello,

    1. Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada
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  • James M. Brophy,

    1. Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada
    2. Departments of Epidemiology and Biostatistics, and of Medicine, McGill University, Montreal, Quebec, Canada
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  • Samy Suissa

    Corresponding author
    1. Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Québec, Canada
    • Departments of Epidemiology and Biostatistics, and of Medicine, McGill University, Montreal, Quebec, Canada
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S. Suissa, Centre for Clinical Epidemiology, Jewish General Hospital, 3755 Cote Ste-Catherine, Montreal, Québec, Canada H3T 1E2. E-mail: samy.suissa@mcgill.ca

ABSTRACT

Introduction

A potential risk of heart failure was recently observed in randomized trials of the dopamine agonist pramipexole. The extent of the risk with this and other dopamine agonists is unknown.

Methods

We used the UK General Practice Research Database (GPRD) to identify all users of anti-parkinsonian drugs, 40–89 years of age, between 1997 and 2009. All incident heart failure cases were identified and classified as probable or possible on the basis of their treatment and mortality. Using a nested case–control approach, each case was matched with up to 10 controls selected among the cohort members. Incidence rate ratios (RR) of heart failure associated with the current use of dopamine agonists were estimated using conditional logistic regression, adjusted for covariates.

Results

The cohort included 26 814 users of anti-parkinsonian drugs, with 783 newly diagnosed with heart failure during follow-up (rate 8.7 per 1000 per year). The incidence rate of heart failure was increased with the current use of any dopamine agonist (RR = 1.58, 95% CI = 1.26–1.96), and particularly so for pramipexole (RR = 1.86, 95%CI = 1.21–2.85) and cabergoline (RR = 2.07, 95%CI = 1.39–3.07), compared with no use. The increase was not significant with ropinirole (RR = 1.23, 95%CI = 0.85–1.97) or pergolide (RR = 1.42, 95%CI = 0.95–2.12). Pramipexole was not associated with a significantly increased rate when compared with all other dopamine agonists collectively (RR = 1.28, 95%CI = 0.82–2.00).

Discussion

The use of dopamine agonists, especially pramipexole and cabergoline, is associated with an increased risk of heart failure. Copyright © 2011 John Wiley & Sons, Ltd.

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