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Diet Pills and Heart Disease

Since the article below was uploaded, there have been several developments in the Fen-phen saga.

1. The American College of Cardiology has published recommendations for these patients (http://www.acc.org/pubs/news/statement.html ). This basically confirms the need for all patients who have taken the drugs to be examined by a physician. Some, particularly those with symptoms of shortness of breath, chest pain, etc. or with a murmur, should undergo an echocardiogram or other cardiac testing. Re-evaluation is urged at 6-8 months.

2. The Centers for Disease Control has issued further information on the data used by the Food and Drug Administration to request voluntary withdrawal of the drug in the November 14, 1997 issue of the MMWR (Morbidity and Mortality Weekly) (http://www.cdc.gov/epo/mmwr/preview/mm4635.html ).

3. Further information has been published by the Food and Drug Administration regarding facts and decisions about diet medications. This information is readable, complete, and in-depth, and will not be repeated here (http://www.fda.gov – search under fenfluramine).

The obesity drugs "Fen-phen" and Redux have received widespread attention virtually since their discovery. Another article recently appeared in the New England Journal of Medicine. This report, which was widely and intentionally leaked to the press several months prior to its publication, surrounded the appearance of another abnormality of the cardiovascular system associated with the use of these agents. Significant and unusual abnormalities of valvular structures were noted in users of fen-phen. This new finding led to the withdrawal of fenfluramine and dexfenfluramine from the market by their manufacturers (phentermine is still available).

We will leave to others the legal and regulatory ramifications of this episode. Suffice it to say, a new group who did not take the drug will get rich from the experience. For some medical and social discussion, please see this month's Commentary.

What is important here is: What should people do who have taken these agents? There is no clear answer, but it would seem to be prudent to see their physician, and have an examination. An evaluation of any current symptoms and a physical examination should be able to discern any serious abnormalities which may have developed. However, the abnormalities associated with the use of fen-phen may not be apparent on physical examination. The most accurate test to discover either PPH or the valvular abnormalities is an echocardiogram (sonogram of the heart). This costs between $400 and $800 however.
Remember this perspective: 18,000,000 prescriptions were written in 1996 alone . . . 24 cases of valvular disease were the basis of the report which led to the discontinuation of the drugs. This is not to say the risks are unimportant . . . it is to emphasize that the risks are low. The practical result of doing an echocardiogram on every patient who took the agents would reach billions of dollars and find relatively few cases. Echocardiograms would be appropriate for those with symptoms or findings to suggest the possibility of PPH or valvular disorders.

Patients who have taken the drugs should note the odds noted above are very much in their favor.

Obesity will remain as a very significant factor in the development of many of the major illnesses of our time. The need for effective weight loss programs and agents will remain. Renewed efforts, and renewed cautions, are needed. The most effective programs will remain the most difficult - regular exercise and a prudent diet. Look for more on this topic on HeartPoint in the future.
ŠCOPY 1997 HeartPoint Updated November 1997

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