The risk of new onset heart failure associated with dopamine agonist use in Parkinson's disease
ABSTRACT The aim of present study was to investigate the risk of heart failure associated with dopamine agonist use in patients with Parkinson's disease. The data sources of this study were four different population-based, healthcare databases in United Kingdom, Italy and Netherlands. A case control study nested within a cohort of Parkinson's disease patients who were new users of either dopamine agonist or levodopa was conducted. Incident cases of heart failure were identified and validated, using Framingham criteria. Controls were matched to cases on age, gender and database. To estimate the risk of newly diagnosed heart failure with ergot and non-ergot derived dopamine agonists, as compared to levodopa, odds ratios and 95% confidence intervals were calculated through conditional logistic regression. In the cohort of 25,459 Parkinson's disease patients (11,151 new users of dopamine agonists, 14,308 new users of levodopa), 518 incident heart failure cases were identified during follow-up. Compared to levodopa, no increased risk of heart failure was found for ergot dopamine agonists (odds ratio: 1.03; 95% confidence interval: 0.69-1.55). Among non-ergot dopamine agonists, only pramipexole was associated with an increased risk of heart failure (odds ratio: 1.61; 95%confidence interval: 1.09-2.38), especially in the first three months of therapy (odds ratio: 3.06; 95% confidence interval: 1.74-5.39) and in patients aged 80 years and older (odds ratio: 3.30; 95% confidence interval: 1.62-7.13). The results of this study indicate that ergot dopamine agonist use in Parkinson's disease patients was not associated with an increased risk of newly diagnosed heart failure. Among non-ergot dopamine agonists, we observed a statistically significant association between pramipexole use and heart failure, especially during the first months of therapy and in very old patients.
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ABSTRACT: Rheumatoid arthritis (RA) is a multisystem disease with a complex immunologic pathophysiology. Likewise, sleep disorders can involve a complicated interplay between the neurologic pathways, immune system, and respiratory system. Recent studies have shown an elevated prevalence of sleep abnormalities in connective tissue disorders compared to the general population. Restless legs syndrome (RLS) may be present in up to 30% of RA patients. These findings may be related to cytokine release and other immunomodulatory responses. TNF- α levels relate to sleep physiology and anti-TNF- α therapy may improve sleep patterns. Most of the patients with this disorder can distinguish their RLS sensations from their arthritic symptoms. RLS is a common comorbidity seen with RA, and prompt recognition and treatment can improve patient quality of life.06/2013; 2013:352782. DOI:10.1155/2013/352782
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ABSTRACT: Introduction: Dopamine agonists (DAs) are frequently used to treat early or advanced Parkinson's disease (PD) patients. They have been shown to be efficacious for the treatment of motor symptoms and for delaying levodopa-induced dyskinesias. However, their utilization is limited by the risk of adverse drug reactions, some of which affect the cardiovascular system. Recently, the US FDA identified a possible association between exposure to pramipexole and the risk of heart failure. Areas covered: This article begins by reviewing the pharmacodynamic and cardiovascular effects of DAs on PD patients. Pharmacoepidemiological studies about the association between DAs and heart failure are then evaluated. Expert opinion: Four nested case-control studies were reviewed. In general, results showed higher heart failure risk following use of pramipexole or cabergoline. Although the effects of cabergoline may be explained by the induction of cardiac valve fibrosis, the basis for the significantly increased risk associated with pramipexole is unclear. It remains to be determined if these are dose-related effects, at what point they occur during the course of treatment, and if the risk is the same for all patients irrespective of other potential modifying factors, such as age and sex.Expert Opinion on Drug Safety 03/2014; 13(3):351-60. DOI:10.1517/14740338.2014.888057 · 2.74 Impact Factor
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ABSTRACT: Critically ill patients are at high risk of adverse drug events during their intensive care unit stay. Of the potential adverse drug events, those related to the cardiovascular system are particularly concerning. Common cardiovascular adverse drug events include drug-induced arrhythmias, drug-induced blood pressure abnormalities, and drug-induced heart failure. The specific drug-induced events to be reviewed include bradycardia, tachycardia, corrected QT interval prolongation, hypertension, hypotension, and heart failure exacerbation.Critical care nursing quarterly 01/2013; 36(4):323-34. DOI:10.1097/CNQ.0b013e3182a10c2a