CardiovascularRiskReductionAssociatedwithPharmacologicalWeightLossTherapy:AMeta-Analysis

Introduction

• Nearly2/3ofAmericansareeitherobeseoroverweight.

• Obesityisaassociatedwithmultiplecardiovasculardisease(CVD)riskfactorssuchashypertension,diabetesanddyslipidemia.

• Therehasbeenanincreaseintheuseofpharmacologicaltherapyfortheobesity.

• Thoughthepharmacologicaltherapieshaveshownbenefitinweightreduction,theclinicalimpactthesemedicaltherapieshaveonoverallCVDoutcomeshasyettobedetermined.

• WeaimedtoassesstheeffectofpharmacologicalagentsusedforweightreductiononCVDriskandall-causemortality.

Methods• Weconductedasystematicmeta-analysisofpeer-reviewedliterature.

• Keywordsusedincluded:“orlistat”,“lorcaserin”,“phentermine/topiramate”or“naltrexone/bupropione”and“cardiovascularoutcomes”amongothers.

•  InclusionCriteria:Quantitativedataoncardiovascularriskfactorssuchas,HemoglobinA1C(A1C),changesinbodymassindex(BMI),bloodpressureandCVDmorbidityandmortality.

Results

Conclusions

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JesseA.KaneMD,IrsaMunirMD,TalhaMehmoodMD,HaroonKamranMD,MenaYacoub,MD,IriniYoussef,MSIV,DeborahR.Gustafson,PhDandSamyI.McFarlaneMD

• Wereviewed791articles,only47studieswererandomizedcontrolledtrialsandonly7studiesfulfilledalltheinclusioncriteria.(Figure1)

• Datawasretrievedfromthesestudiesandevaluatedwithcomprehensivemeta-analysissoftwaretoassesspooledeffectsformedicalmanagementversusplacebo.

• Therewereatotalof18,598subjects,ofwhich8,685wereintheintervention(INT)groupand9,913inthecontrol(CTRL)group.(Table1)

Figure1

• Therewere45allcausemortalityeventsintheINTand55intheCTRLgroups.(OR:0.843,95%CI:0.571-1.244,Z:-0.860,P:0.390).(Figure2)

Control±SD Intervention±SD

TotalPatients 9,913 8,685

Age(yr) 55.01 53.73

PercentFemale(%) 62.64 65.83

MeanWeight(kg) 104.29±17.50 103.27±17.33

SystolicBloodPressure(mmHg)

126.91±12.81 126.70±12.91

DiastolicBloodPressure(mmHg)

77.67±8.75 77.80±8.73

HemoglobinA1C(%) 5.85±0.599 5.85±0.593

PatientDemographicData

• ThewassignificantlyhigherpercentweightreductionfortheINTgroupcomparedtotheCTRLgroup(Hg:-0.431,95%CI:-0.477--0.385,Z:-18.472,P<0.001).

• BloodpressurereductionwashigherfortheINTgroupcomparedtotheCTRLgroup.(Hg:-0.052,95%CI:-0.101--0.003,Z:-2.086,P:0.037).

• TheheterogeneityobservedforourmetaanalysisisQ:1.884,df:6,P:0.930.

• TherewasasignificantreductionCVDmortality,17eventsintheINTand36eventsintheCTRL(OR:0.496,95%CI:0.282-0.873,Z:-2.433,P:0.015).(Figure3)

• TherewasasignificantabsolutereductioninA1CintheINTgroup(Hg:-0.238,95%CI:-0.291--0.186,Z:-8.937,P<0.001).

AllCauseMortality

CardiovascularMortality*

Figure2

Figure3

• Ourstudydemonstratedthesignificanteffectofpharmacologicalweightreductiononweightloss,bloodpressure,glycemiccontrolandCVDmortality.

•WeightlossmedicationslikelyimpactCVDmortalityandriskfactorsviaweightreductionandnotdirectmedicationeffect.

•Giventhelimitedefficacyoflifestylemodificationonsustainedweightlossandthesurgicalriskandlimitedavailabilityofbariatricsurgery,pharmacologicalweightlossmaybeavaluabletreatmentoptiontoreduceCVDriskinobesepatients.

•FurtherresearchshouldbeperformedtoclarifytheimplicationsthesetherapieshaveonoverallmortalityandevaluatethemechanismsbywhichthesemedicationsreduceCVDriskfactorsandmortality.