Cabergoline-Induced Hypoprolactinemia May Attenuate Cardiometabolic Effects of Atorvastatin: A Pilot Study

Abstract

Introduction: Hypoprolactinemia, which is usually a consequence of treatment with inadequate high doses of dopaminergic agents, is a poorly understood clinical condition. The aim of the current study was to investigate whether the cardiometabolic effects of statin therapy differ between patients with low prolactin production and patients with normal levels of this hormone. Methods: We studied two groups of cabergoline-treated premenopausal women with hypercholesterolemia matched for age, plasma lipids, cabergoline dose, and treatment duration: 11 women with hypoprolactinemia (group A) and 15 women with plasma levels of this hormone within the reference range (group B). The control group (C) included 25 dopaminergic-naïve normoprolactinemic women, matched for age and lipid levels. Plasma lipids, insulin sensitivity, and levels of uric acid, high-sensitivity C-reactive protein (hsCRP), fibrinogen, homocysteine, and 25-hydroxyvitamin D were measured before and after 14-week treatment with atorvastatin (20 mg daily). Results: Patients with hypoprolactinemia were more insulin-resistant, had lower values of total testosterone and free androgen index, and had higher levels of hsCRP and fibrinogen than individuals with normal prolactin levels. Although atorvastatin reduced total and LDL cholesterol and hsCRP in all study groups, this effect was stronger in groups B and C than in group A. Only in groups B and C, the drug decreased uric acid, fibrinogen, and homocysteine and increased 25-hydroxyvitamin D. In turn, only in group A, atorvastatin worsened insulin sensitivity and reduced free androgen index. Conclusion: Coexisting hypoprolactinemia may have an unfavorable impact on the pleiotropic effects of statins.