Drolet Benoit, Simard Chantale, Poirier Paul
Institut Universitaire de Cardiologie et de Pneumologie, Laval Hospital, Quebec City, Quebec, Canada.
Am J Cardiovasc Drugs. 2007;7(4):273-88. doi: 10.2165/00129784-200707040-00005.
Overweight and obesity have been rising dramatically worldwide and are associated with numerous co-morbidities such as cardiovascular disease (CVD), type 2 diabetes mellitus, hypertension, certain cancers, and sleep apnea. In fact, obesity is an independent risk factor for CVD and CVD risks have also been documented in obese children. The majority of overweight and obese patients who achieve a significant short-term weight loss do not maintain their lower bodyweight in the long term. This may be due to a lack of intensive counseling and support from a facilitating environment including dedicated healthcare professionals such as nutritionists, kinesiologists, and behavior specialists. As a result, there has been a considerable focus on the role of adjunctive therapy such as pharmacotherapy for long-term weight loss and weight maintenance. Beyond an unfavorable risk factor profile, overweight and obesity also impact upon heart structure and function. Since the beginning, the quest for weight loss drugs has encountered warnings from regulatory agencies and the withdrawal from the market of efficient but unsafe medications. Fenfluramine was withdrawn from the market because of unacceptable pulmonary and cardiac adverse effects. Nevertheless, there is extensive research directed at the development of new anti-obesity compounds. The effect of these molecules on CVD risk factors has been studied and reported but information regarding their impact on the cardiovascular system is sparse. Thus, instead of looking at the benefit of weight loss on metabolism and risk factor management, this article discusses the impact of weight loss medications on the cardiovascular system. The potential interaction of available and potential new weight loss drugs with heart function and structure is reviewed.
超重和肥胖在全球范围内急剧上升，并与多种合并症相关，如心血管疾病（CVD）、2型糖尿病、高血压、某些癌症和睡眠呼吸暂停。事实上，肥胖是心血管疾病的独立危险因素，肥胖儿童也存在心血管疾病风险。大多数在短期内实现显著体重减轻的超重和肥胖患者，长期来看并不能维持较低体重。这可能是由于缺乏来自有利环境的强化咨询和支持，包括营养学家、运动生理学家和行为专家等专业医疗人员。因此，人们相当关注辅助治疗的作用，如药物治疗在长期减肥和维持体重方面的作用。除了不利的风险因素外，超重和肥胖还会影响心脏结构和功能。从一开始，减肥药的研发就受到监管机构的警告，一些有效但不安全的药物也被撤出市场。芬氟拉明因不可接受的肺部和心脏不良反应而被撤出市场。尽管如此，仍有大量研究致力于开发新的抗肥胖化合物。这些分子对心血管疾病危险因素的影响已被研究和报道，但关于它们对心血管系统影响的信息却很少。因此，本文不是探讨减肥对代谢和危险因素管理的益处，而是讨论减肥药物对心血管系统的影响。本文综述了现有和潜在的新型减肥药物与心脏功能和结构的潜在相互作用。
