Relação entre o uso de crônico de cabergolina e o desenvolvimento de valvulopatia cardíaca na acromegalia

Abstract

Introduction: Cabergoline (CAB), a dopamine agonist derived from ergot, is used to treat endocrine disorders, including acromegaly. At high doses, as used in Parkinson’s disease, its use has been associated with clinically significant valvular heart lesions. In patients with hyperprolactinemia treated with lower doses, the risk appears reduced but is not yet fully clarified. In acromegaly, a condition with an intrinsically high risk of valvular disease, evidence regarding the impact of chronic CAB use on the valvular apparatus remains limited. Objectives: This study evaluated the frequency and severity of valvular heart lesions in acromegaly patients treated with cabergoline over a prolonged period. Methods: A historical prospective cohort study was conducted involving 31 patients with acromegaly. Participants were divided into current or previous CAB users (n=24) and never-users (n=7). All underwent clinical and echocardiographic evaluations to identify functional and morphological valvular changes, in addition to cumulative cabergoline dose calculation. Results: The mean age of participants was 58 ± 12 years, with a predominance of females (68%). The mean duration of cabergoline (CAB) use was 130 ± 52 months, with a median cumulative dose of 1,353 mg. After 10 years, it was observed that there was no significant difference in the frequency of any grade of valvular regurgitation, increasing from 38% to 57% among CAB users (p = 0.134) and from 14% to 71% among non-users (p = 0.134), with no difference between groups (p = 0.668). Valvular morphological changes increased, without statistical significance, from 43% to 67% in CAB users (p = 0.074) and from 29% to 57% in non-users (p = 0.617), with no difference between groups (p = 0.674). Statistical analysis included Mann–Whitney, Pearson’s chi-square or Fisher’s exact test, and McNemar’s test to evaluate categorical changes between 2013 and 2025, with significance set at p<0.05. Conclusions: Long-term cabergoline therapy, at doses commonly used in acromegaly, was not associated with an increased risk of valvular heart disease. The observed valvular changes were mild and likely related to underlying acromegaly and aging rather than CAB exposure. These findings support the cardiovascular safety of cabergoline as an adjuvant treatment for acromegaly.