Appetite Suppressants and Valvular Heart Disease

  title={Appetite Suppressants and Valvular Heart Disease},
  author={Neil Weissman},
  journal={The American Journal of the Medical Sciences},
  • N. Weissman
  • Published 1 April 2001
  • Medicine
  • The American Journal of the Medical Sciences
The association between valvular heart disease and diet pills was discovered several years ago in a small cohort of patients. Subsequent uncontrolled surveys and reports suggested a prevalence of cardiac abnormalities as high as 30%. These results led to widespread concern by millions of appetite suppressant users and the withdrawal of both fenfluramine and dexfenfluramine from the market. Through this review of the literature, it becomes apparent that we have better defined the association… 

Pulmonary Hypertension Associated with Use of Phentermine

Phentermine has been considered a relatively safe drug to treat obesity, and further investigation is needed to decide the safety and dosage of phentermine.

Valvular regurgitation and surgery associated with fenfluramine use: an analysis of 5743 individuals

Regurgitant valvulopathy was common in individuals exposed to fenfluramines, more frequent in females, and associated with duration of use in all valves assessed and the incidence of surgery appeared to be substantially increased compared with limited general population data.

Drug-induced heart failure.

  • Carleton B MaxwellA. T. Jenkins
  • Medicine, Biology
    American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
  • 2011
A literature search was conducted to identify reports of new-onset HF and exacerbations of HF associated with medication use published from 1960 to January 2011, finding a variety of agents associated with drug-induced HF.

Pharmacotherapy of obesity.

  • N. Finer
  • Medicine
    Best practice & research. Clinical endocrinology & metabolism
  • 2002
Advances in understanding of the mechanism of weight control, together with improved ways of evaluating anti-obesity drugs, has resulted in two effective compounds, sibutramine and orlistat, becoming available for clinical use.

Safety of Drug Therapies Used for Weight Loss and Treatment of Obesity

The safety and efficacy of currently approved drug therapies have not been evaluated in children and elderly patient populations and there is limited information in adolescents, whilst the long-term safety of current and potential new drug therapies in adults will require several years of postmarketing surveillance to fully elucidate their adverse effect profiles.

Cardiac Valvulopathy Associated with Pergolide Use

Pergolide therapy is associated with an increased risk of developing cardiac valvulopathy but the true incidence and importance of this remains unknown and further prospective studies are needed with standardized assessments of echocardiograms.

New Perspectives and Pharmacotherapies

There is a widespread epidemic of obesity in the United States, which has been associated with an increased risk of diabetes mellitus, cancer, and cardiovascular diseases, and the continued availability of U.S. Food and Drug Administration-approved pharmacotherapies has expanded the options for the management of obesity.

Cardiovascular safety of fenfluramine in the treatment of Dravet syndrome: Analysis of an ongoing long‐term open‐label safety extension study

The cardiovascular safety profile of low‐dose fenfluramine when used in a pediatric population to reduce seizure frequency in patients with Dravet syndrome is characterized.

Recent and Future Drugs for the Treatment of Obesity

It has previously been shown that an intentional modest weight reduction may lead to a marked improvement in cardiovascular risk factors and a substantial reduction—up to 20—25%—in comorbidity (Table 31).



A population-based study of appetite-suppressant drugs and the risk of cardiac-valve regurgitation.

The use of fenfluramine or dexfen fluramine, particularly for four months or longer, is associated with an increased risk of newly diagnosed cardiac-valve disorders, particularly aortic regurgitation.

Natural History of Valvular Regurgitation 1 Year after Discontinuation of Dexfenfluramine Therapy

Assessing change in valvular regurgitation by using a side-by-side reading method 1 year after dexfenfluramine therapy was discontinued found no statistical difference among the groups, according to U.S. Food and Drug Administration criteria.

Risk for Valvular Heart Disease among Users of Fenfluramine and Dexfenfluramine Who Underwent Echocardiography before Use of Medication

To estimate the risk for medication-associated valvular heart disease, users of fenFLuramine or dexfenfluramine who underwent echocardiography before beginning therapy with these medications were identified and compared these eChocardiograms to those obtained after therapy was discontinued.

Fenfluramine and phentermine and cardiovascular findings: effect of treatment duration on prevalence of valve abnormalities.

The findings suggest that valvular abnormalities in patients who took fenfluramine-phentermine primarily involve those who had taken these medications for >6 months and predominantly results in mild aortic regurgitation.

The prevalence of cardiac valvular insufficiency assessed by transthoracic echocardiography in obese patients treated with appetite-suppressant drugs.

Obese patients who took fen fluramine and phentermine, dexfenfluramine alone, or dexfanfluramines and phen termine for various periods had a significantly higher prevalence of cardiac valvular insufficiency than a matched group of control subjects.

Cardiac valvulopathy associated with exposure to fenfluramine or dexfenfluramine: U.S. Department of Health and Human Services interim public health recommendations, November 1997.

The data used by FDA in its decision to request voluntary withdrawal of these drugs from the market is summarized, and interim public health recommendations for persons exposed to these drugs are presented.

Valvular abnormalities and cardiovascular status following exposure to dexfenfluramine or phentermine/fenfluramine.

Evaluating cardiovascular status and the prevalence of valvular abnormalities, as assessed by clinical cardiovascular parameters and echocardiography, in patients treated for obesity with dexfenfluramine or phentermine/fen Fluramine indicates that use of dexfinfluramines and phentermin/fen fluramine is associated with an increase in the prevalenceof AR, but was not associated with a increase inThe prevalence of MR using FDA criteria or with serious cardiac events.

Guidelines for the management of patients with valvular heart disease: executive summary

These guidelines follow the format established in previous American College of Cardiology/American Heart Association (ACC/AHA) guidelines for classifying indications for diagnostic and therapeutic procedures, and make recommendations for diagnostic testing, treatment, and physical activity.

Prevalence and determinants of valvulopathy in patients treated with dexfenfluramine.

BACKGROUND Valve regurgitation has been associated with dexfenfluramine, but its prevalence and severity are uncertain. Additional factors that may contribute to valve regurgitation in patients