Cabergoline therapy and the risk of cardiac valve regurgitation in patients with hyperprolactinemia: A meta-analysis from clinical studies

Dopamine agonists have been associated with increased risk of cardiac valve regurgitation in patients with Parkinson's disease. Whether these drugs might be harmful for patients with hyperprolactinemia is still unsettled. Occasional case reports and 7 studies on the relationship between cabergoline and cardiac valve regurgitation have been published so far. Overall, cabergoline has been considered a safe therapy, although some studies suggested an increased prevalence of cardiac valve regurgitation. The aim of this meta-analysis was to assess the effects of cabergoline on cardiac valve regurgitation. Eligible studies were all trials using cabergoline in patients with either tumor or non-tumor hyperprolactinemia. Our search was updated to October 2008. Pooled data from the 6 selected studies showed that treatment with cabergoline was associated with increased risk of tricuspid valve regurgitation (fixed effects: prevalence ratio=1.40; 95% confidence interval: 1.17-1.67); on the contrary, patients treated with cabergoline and control subjects did not differ in prevalence of aortic or mitral valve regurgitation. This meta-analysis shows that patients with hyperprolactinemia treated with cabergoline are at increased risk of regurgitation of the tricuspid valve. However, regurgitation was only an echocardiographic finding since no patient had symptoms of valvular disease. This meta-analysis underscores that echocardiography is recommended in all patients with hyperprolactinemia who are candidate to be treated with or are under cabergoline therapy; monitoring cardiac valves is also recommended although precise follow-up for these patients will be likely provided by future longitudinal studies.