Appetite-suppressing drugs and valvular heart disease

The popular diet drugs, fenfluramine and dexfenfluramine, were withdrawn from the market in the United States after the publication of an association of these drugs with valvulopathy in a small series of patients, spontaneous reports to the Food and Drug Administration, and echocardiographic surveys that suggested a valvulopathy prevalence of 32.8% among diet drug users. Subsequent publications suggested that there is an association of these agents with valvulopathy, but that the prevalence seems lower than initially suspected. This review examines the available prevalence data and attempts to account for some of the variability in these data. Potential pathophysiologic mechanisms are discussed and management guidelines for these patients are provided. This is an area of ongoing study and more information about the natural history of these lesions will certainly be forthcoming. A review of the data reveals that the withdrawal of these agents was prudent and likely prevented further harm.