Risk of cardiovascular events associated with necessary interventions for Parkinson disease

JAMES CRISPO; SANTIAGO PEREZ LLORET

Congreso; 19th International Congress of Parkinson's Disease and Movement Disorders; 2015

After levodopa, dopamine agonists (DAs) are drugs most frequently used in the treatmentof Parkinson disease (PD). They are classified as ergot-derivatives (bromocriptine,cabergoline, lisuride, and pergolide) or non-ergot derivatives (apomorphine, piribedil,pramipexole, ropinirole, and rotigotine) and may be used alone or as adjunct therapy.Several epidemiologic studies demonstrated that pergolide was associated withvalvulopathy prior to its voluntary withdrawal from the US market. Recently, attention hasshifted to non-ergot DAs and possible risks of adverse cardiovascular outcomes such asheart failure (HF). Following a review of phase II/III clinical trial data for pramipexole,investigators found that, compared to placebo, HF was more frequently diagnosed amongpramipexole users. Although these results serve as useful preliminary data, they do notreflect real world prescribing conditions. Additionally, levodopa users may represent a moreappropriate reference group when investigating associations between DAs andcardiovascular events, since levodopa users are more likely to be older and presumablyhave more severe PD. Signals detected from such analyses are less likely to overestimatethe level of patient risk due to low baseline risk in the referent group.To investigate non-ergot DA safety, we examined the relationship between non-ergot DAsand adverse cardiovascular events in a PD inpatient population.