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Appetite suppressants and valvular heart disease
Frank F Seghatol1, Vera H Rigolin
1Department of Medicine, Division of Cardiology, Northwestern University Medical School, Chicago, Illinois 60611, USA.
Current Opinion in Cardiology
|October 3, 2002
Summary
Appetite suppressants like fenfluramine caused valvular lesions in many patients. However, most cases of drug-induced valve disease were mild and improved after stopping the medication.
Area of Science:
- Cardiology
- Pharmacology
- Obesity Medicine
Background:
- Fenfluramine, dexfenfluramine, and phentermine were used for obesity management.
- These drugs were withdrawn in 1997 due to reports of valvular lesions.
Purpose of the Study:
- To review the incidence and characteristics of valvular lesions associated with appetite suppressant therapy.
- To discuss the potential mechanisms and echocardiographic features of this drug-induced valvulopathy.
Main Methods:
- Review of post-marketing surveillance data and follow-up studies.
- Analysis of echocardiographic findings in patients treated with fenfluramine, dexfenfluramine, or phentermine.
Main Results:
- Valvular lesions affected nearly one-third of patients treated with these appetite suppressants.
- Most valvulopathies were mild to moderate, rarely requiring surgical intervention.
- Improvement in valvular function was observed after drug discontinuation.
Conclusions:
- Appetite suppressant-induced valvular disease is generally reversible.
- Serotonergic effects are a potential mechanism for the observed valve damage.
- Routine follow-up and endocarditis prophylaxis are typically sufficient; surgery is rare.