The risk of cardiovascular complications with current obesity drugs

ABSTRACT

Introduction

Obesity is associated with an increased risk of cardiovascular morbidity and mortality. Four medications are approved by the US Food and Drug Administration (FDA) for chronic weight management when used as an adjunct to a reduced-calorie diet and increased physical activity in adults. These medications result in clinically significant weight losses, as well as improvements in some cardiometabolic risk factors.

Areas covered

We briefly review the history of anti-obesity medications (AOMs) as related to cardiovascular safety, and summarize weight loss efficacy and cardiovascular data from clinical trials of orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide.

Expert opinion

Current AOMs approved for chronic weight management have generally favorable effects on some cardiometabolic parameters. However, the long-term safety of orlistat, phentermine/topiramate, and naltrexone/bupropion on cardiovascular morbidity and mortality have not been established. The cardiovascular safety of liraglutide, at a dose of 1.8 mg/d, was demonstrated in a large randomized outcomes trial in participants with type 2 diabetes.

KEYWORDS:

• Cardiovascular
• cardiovascular disease outcomes
• obesity
• pharmacotherapy
• weight loss

Article highlights

• The current anti-obesity medications (AOMs) approved by the Food and Drug Administration for chronic weight management are orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide.

• AOMs generally have favorable effects on cardiometabolic parameters.

• The long-term safety of orlistat, phentermine/topiramate, and naltrexone/bupropion on cardiovascular morbidity and mortality has not been established, and future studies are needed to examine the effects of these medications.

• The cardiovascular safety of liraglutide was demonstrated in a large randomized cardiovascular outcomes trial in participants with type 2 diabetes.

• New AOMs are needed which produce greater weight losses and have favorable risk-benefit profiles.

This box summarizes key points contained in the article.

Declaration of interest

AM Chao reports grants and personal fees from WW International Co, outside the submitted work. TA Wadden reports serving on advisory boards for Novo Nordisk and WW International Co and receiving grants from both companies. RI Berkowitz reports serving on an advisory board for WW International Co and receiving a grant from Eisai Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

AM Chao was supported, in part, by the National Institute of Nursing Research of the National Institutes of Health under Award Number [K23NR017209].