Valvular heart disease and the use of dopamine agonists for Parkinson's disease

N Engl J Med. 2007 Jan 4;356(1):39-46. doi: 10.1056/NEJMoa054830.


Background: Ergot-derived dopamine receptor agonists, often used in the treatment of Parkinson's disease, have been associated with an increased risk of valvular heart disease.

Methods: We performed an echocardiographic prevalence study in 155 patients taking dopamine agonists for Parkinson's disease (pergolide, 64 patients; cabergoline, 49; and non-ergot-derived dopamine agonists, 42) and 90 control subjects. Valve regurgitation was assessed according to American Society of Echocardiography recommendations. The mitral-valve tenting area was also measured and used as a quantitative index for leaflet stiffening and apical displacement of leaflet coaptation.

Results: Clinically important regurgitation (moderate to severe, grade 3 to 4) in any valve was found with significantly greater frequency in patients taking pergolide (23.4%) or cabergoline (28.6%) but not in patients taking non-ergot-derived dopamine agonists (0%), as compared with control subjects (5.6%). The relative risk for moderate or severe valve regurgitation in the pergolide group was 6.3 for mitral regurgitation (P=0.008), 4.2 for aortic regurgitation (P=0.01), and 5.6 for tricuspid regurgitation (P=0.16); corresponding relative risks in the cabergoline group were 4.6 (P=0.09), 7.3 (P<0.001), and 5.5 (P=0.12). The mean mitral tenting area was significantly greater in ergot-treated patients and showed a linear relationship with the severity of mitral regurgitation. Patients treated with ergot derivatives who had grade 3 to 4 regurgitation of any valve had received a significantly higher mean cumulative dose of pergolide or cabergoline than had patients with lower grades.

Conclusions: The frequency of clinically important valve regurgitation was significantly increased in patients taking pergolide or cabergoline, but not in patients taking non-ergot-derived dopamine agonists, as compared with control subjects. These findings should be considered in evaluating the risk-benefit ratio of treatment with ergot derivatives.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cabergoline
  • Case-Control Studies
  • Dopamine Agonists / adverse effects*
  • Ergolines / adverse effects*
  • Female
  • Heart Valve Diseases / chemically induced*
  • Heart Valve Diseases / diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / pathology
  • Parkinson Disease / complications
  • Parkinson Disease / diagnostic imaging
  • Parkinson Disease / drug therapy*
  • Pergolide / adverse effects*
  • Regression Analysis
  • Risk
  • Serotonin 5-HT2 Receptor Agonists*
  • Serotonin Receptor Agonists / adverse effects
  • Ultrasonography


  • Dopamine Agonists
  • Ergolines
  • Serotonin 5-HT2 Receptor Agonists
  • Serotonin Receptor Agonists
  • Pergolide
  • Cabergoline