Burden of cardiovascular disease in elderly with Parkinson's disease who start a dopamine agonist agent

In recent years, some concerns have been raised about the association between the use of pergolide or cabergoline, ergotderived DA, and the development of fibrotic valvular heart disease. AIM: To characterize the users of ergot-derived DAs and those that are not ergot derived in clinical practice, with particular regard to cardiovascular diseases, using a general practice database. Of almost 120,000 subjects registered in the lists of 93 general practitioners enrolled, 1-year incident users of ergot- (cabergoline, lisuride, pergolide, and bromocriptine) and non-ergot-derived (pramipexole and ropinirole) DAs who had PD in 2004 or 2005 were selected. Almost 70% of incident users of ergot-derived DAs were aged 65 and older (less than users of non-ergot-derived DAs), in contrast with international guidelines. A higher proportion (20%) of users of ergot-derived DAs have more than three concomitant CV diseases than do users of non-ergot-derived DAs (8%). Patients who start a therapy with ergotderived DAs are more likely (Po.05) to have heart failurethan those who use non-ergot-derived DAs. a significantly higher proportion (Po.05) of patients starting treatment with ergotderived DAs concomitantly received three or more cardiovascular medications than of users of non-ergotderived DAs. Overall, incident users of ergot-derived DAs ( 85% of these being cabergoline users) seem to have a worse cardiovascular profile than users of non-ergotderived DAs. This finding should be considered in light of the warning of the heart valvular fibrosis risk associated with use of ergot-derived DAs in patients with PD