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Primary pulmonary hypertension and fenfluramine use
F Brenot1, P Herve, P Petitpretz
1Service de Pneumologie-Réanimation, Hôpital Antoine Béclère, Paris, France.
British Heart Journal
|December 1, 1993
Summary
Fenfluramine use, particularly in women, is linked to primary pulmonary hypertension (PPH). This study found fenfluramine may precipitate or hasten PPH development, challenging previous notions of milder outcomes.
Area of Science:
- Cardiology
- Pulmonology
- Pharmacology
Background:
- Primary pulmonary hypertension (PPH) risk factors are not fully understood.
- Appetite suppressants, including fenfluramine derivatives, are suspected etiological agents in PPH.
- Previous studies suggested PPH associated with fenfluramine might be less severe.
Purpose of the Study:
- To evaluate fenfluramine use as a risk factor for PPH.
- To assess the clinical and hemodynamic characteristics of PPH patients with a history of fenfluramine use.
- To compare the severity and outcome of PPH in fenfluramine users versus non-users.
Main Methods:
- Retrospective study of 73 PPH patients over 5 years.
- Evaluation of fenfluramine use history and temporal relation to symptoms.
- Right heart catheterization and histological examination of lung tissue.
Main Results:
- Fifteen percent of PPH patients (20%) reported fenfluramine use, all women.
- A close temporal relationship was observed between fenfluramine use and exertional dyspnea in most users.
- Histology showed advanced plexogenic pulmonary arteriopathy in fenfluramine users, similar to controls, contradicting earlier reports of milder disease.
Conclusions:
- Fenfluramine may precipitate or accelerate the development of PPH.
- PPH associated with fenfluramine appears to be severe, with no significant difference in survival compared to non-users.
- Further research, like case-control studies, is needed to clarify risk factors and the fenfluramine-PPH relationship.