The ORlistat and CArdiovascular risk profile in patients with metabolic syndrome and type 2 DIAbetes (ORliCARDIA) study

SUMMARY

Background: Metabolic syndrome (MetSyn) is associated with a marked increase in the risk of cardiovascular disease, especially in patients with type 2 diabetes mellitus (DM).

Aim: To investigate the effect of orlistat plus hypocaloric diet (HCD) vs HCD alone on the cardiovascular risk profile in patients with both MetSyn (National Cholesterol Educational Program – NCEP – Adult Treatment Panel III definition) and type 2 DM.

Methods: This was a prospective, multicentre, open-label, randomized, controlled study. One hundred and twenty-six patients, free of cardiovascular disease at baseline, were included in the final analysis. Ninety-four (73%) patients were treated with orlistat (360 mg/day) and HCD for a 6-month period, while 34 (27%) were on HCD alone. Analysis of covariance was used to assess differences between the treatment groups over time.

Main outcome measures: Components of the MetSyn criteria assessed were: waist circumference; systolic and diastolic blood pressure; fasting glucose, triglycerides; high-density lipoprotein cholesterol (HDL-C) plus body mass index; glycosylated haemoglobin (HbA_1C); homeostasis model for assessment of insulin resistance (HOMA) index; and total and low-density lipoprotein cholesterol (LDL-C).

Results: By protocol, all patients had MetSyn at baseline. After a 6 month treatment period there were significant differences between the orlistat plus HCD vs the HCD-alone groups in body weight ( p = 0.0001), waist circumference ( p < 0.0001), fasting glucose ( p < 0.0001), HbA_1C ( p < 0.0001), systolic blood pressure ( p = 0.024), total cholesterol ( p < 0.0001), LDL-C ( p = 0.034), and HOMA index ( p = 0.022), while there were no significant differences in triglycerides and HDL-C. Orlistat was well tolerated. By the end of the study, 65% of the patients on orlistat plus HCD were still meeting the MetSyn criteria and 41% had four to five MetSyn components vs 91% ( p < 0.0001) and 53% ( p = 0.017), respectively, of those on HCD alone.

Conclusions: Orlistat plus HCD favourably modified several cardiovascular risk factors in patients with both MetSyn and type 2 DM. These effects might partly offset the excess cardiovascular risk and improve outcome in this patient population.

Key words: :

• Cardiovascular risk
• Diabetes
• Diet
• Metabolic syndrome
• Orlistat