Parkinson’s, T2D drug affords cardioprotection in youth with T1D

Bromocriptine quick release, a medication used for Parkinson’s disease and type 2 diabetes (T2D), appears to confer cardiovascular benefits such as lower blood pressure (BP) and reduced aortic stiffness in teenagers with type 1 diabetes (T1D), according to data from the BCQR-T1D study.

"We know that abnormalities in the large vessels around the heart, the aorta and its primary branches, begin to develop in early childhood in people with T1D," said principal investigator Dr Michal Schäfer from the University of Colorado School of Medicine in Aurora, Colorado, US.

"We found that bromocriptine has the potential to slow down the development of those abnormalities and decrease the risk for cardiovascular disease in this population," Schäfer added.

After 4 weeks of treatment, bromocriptine treatment reduced systolic BP by 5 mm Hg (95 percent confidence interval [CI], −3 to −7) and diastolic BP by 2 mm Hg (95 percent CI, −4 to 0) as compared with placebo (p<0.001 and p=0.039, respectively). [Hypertension 2022;doi:10.1161/HYPERTENSIONAHA.122.19547]

In addition, bromocriptine produced significant changes in aortic stiffness in terms of lowered pulse wave velocity in the ascending aorta (−0.4 m/s; p=0.018) and increased distensibility (0.08 percent per mm Hg; p=0.017). In the thoraco-abdominal aorta, the drug was associated with a 0.2 m/s reduction in pulse wave velocity (p=0.007) and 0.05 percent/mm Hg increase in distensibility (p=0.013).

"A stiff aorta predisposes a patient to other health issues, such as organ dysfunction or atherosclerosis and higher stress or strain on cardiac muscle," Schäfer pointed out.

"We were able to take it a notch further and show, using more sophisticated metrics, that these central large arteries are impaired, and impairment among adolescents and young adults with T1D may be decelerated with this drug," he said.

BCQR-T1D was a double-blinded, crossover study that included 34 adolescents (mean age 15.9 years, mean body mass index percentile 71.4 percent) with T1D, with a median disease duration of 5.8 years and mean haemoglobin A1c of 8.6 percent.

The participants were randomized to receive bromocriptine quick-release therapy or placebo once daily for 4 weeks. After a washout period of 4 weeks, the participants in each group received the alternative treatment, with each serving as their own control for comparison. All of them had magnetic resonance imaging data.

The study was limited by its small sample size. The investigators called for longer-term and larger studies to further shed light to bromocriptine's impact on vascular health in a greater number of people with T1D.