Dopamine agonist use and the risk of heart failure

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.