Risk of heart failure associated with dopamine agonists: a nested case-control study

Abstract

Background: Recent evidence has emerged that a dopamine agonist, pramipexole, may increase the risk of heart failure among Caucasian patients, but the association has not been examined among Asian patients. The aim of this study was to explore the relationship between use of dopamine agonists and the risk of heart failure.

Methods: Using data from Taiwan's National Health Insurance research database (NHIRD), we identified a population-based cohort comprising 27,135 patients who were prescribed anti-parkinsonian drugs between 2001 and 2010. We conducted a nested case-control study in which 1,707 cases of newly diagnosed heart failure were matched to 3,414 controls (1:2 matched according to age, gender and cohort entry year) within this cohort. Multivariable conditional logistic regressions were used to estimate the association between use of dopamine agonists and heart failure.

Results: An increased risk of heart failure was observed with current use of ergot-derived dopamine agonists (adjusted odds ratio [OR] 1.46, 95 % confidence interval [CI] 1.00-2.12) but not with current use of non-ergot-derived dopamine agonists (adjusted OR 1.24, 95 % CI 0.84-1.82). Among non-ergot-derived dopamine agonists, both pramipexole (adjusted OR 1.40, 95 % CI 0.75-2.61) and ropinirole (adjusted OR 1.22, 95 % CI 0.76-1.95) showed a non-significantly increased heart failure risk. Although the findings of our study were limited by lack of statistical power, a clear pattern of an increased duration of pramipexole use and an increased risk of heart failure were observed.

Conclusion: Use of dopamine agonists, including pramipexole, was associated with non-significantly increased risks of heart failure in this population-based study in Taiwan. Further investigation is needed to clarify this potential association.