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ABSTRACT
Introduction: Obesity is a growing health problem that has numerous comorbidities, including cardiovascular disease (CVD). The multi-disciplinary treatment of obesity now includes the use of pharmacotherapy. When treating patients with obesity and CVD, certain medications may be more appropriate than others.
Areas covered: Herein, the authors review the most commonly used FDA approved medications for the treatment of obesity, describing their mechanism of action, and the efficacy and safety of the medications as seen in recent studies, particularly in patients with CVD.
Expert opinion: In the population of patients with obesity and CVD, the medications orlistat, lorcaserin and liraglutide are considered the most appropriate options for their treatment, in terms of safety. Sympathomimetic medications, such as phentermine, should be avoided in this group. The recent CAMELLIA-TIMI 61 trial supports the safety of lorcaserin in patients with CVD. Until there are more studies, it is reasonable to extrapolate the findings of the LEADER trial, which found improved CV outcomes in subjects with type 2 diabetes taking liraglutide, to the population of nondiabetic patients being treated for obesity. Further cardiovascular outcomes trials (CVOT) are needed to assess the safety of other pharmacotherapeutic options for weight loss.
Article highlights
Obesity is a significant risk factor for cardiovascular disease (CVD), and both obesity and CVD can significantly increase a patient’s risk of morbidity and mortality.
Optimal treatment of obesity includes lifestyle interventions. Anti-obesity pharmacotherapy approved by the Food and Drug Administration (FDA) can be used as adjunctive therapy in patients who have been unable to achieve and maintain clinically significant weight loss with behavioral modifications alone.
Certain anti-obesity medications are appropriate for use in patients with obesity and CVD. Others are contraindicated or should be used with caution in this population of patients.
Further cardiovascular outcomes trials (CVOT) are needed to assess the safety and efficacy of anti-obesity medications.
Medications currently approved for the treatment of type 2 diabetes may offer safe and effective options for the future treatment of obesity and CVD.
This box summarizes key points contained in the article.
Declaration of interest
LJ Aronne declares receiving consultancy fees from, as well serving on or partaking on advisory boards of ERX Pharmaceutical LLC, Jamieson Laboratories, Pfizer Inc, Novo Nordisk, Sanofi, Eisai, Janssen Pharmaceuticals, UnitedHealth group Ventures and Gelesis. They also declare being the recipient of research funding from Aspire Bariatrics, Eisai, AstraZeneca and Novo Nordisk as well as having an equity interest in BMIQ, ERX Pharmaceutical LLC, Zafgen, Gelesis, MYOS and Jamieson Laboratories. Finally, they serve on the board of directors of MYOS, BMIG and Jamieson Laboratories. 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 apart from those disclosed.
Reviewer Disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.