a Department of Medicine , Hospital for Special Surgery , New York , NY , USA.
b Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine , Comprehensive Weight Control Center , New York , NY , USA.
Expert Opin Pharmacother. 2019 Apr;20(5):585-593. doi: 10.1080/14656566.2018.1561867. Epub 2019 Jan 7.
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.
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.
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.
肥胖是一个日益严重的健康问题，它有许多并发症，包括心血管疾病（CVD）。肥胖的多学科治疗现在包括药物治疗。在治疗肥胖和 CVD 的患者时，某些药物可能比其他药物更合适。
本文作者回顾了美国食品和药物管理局（FDA）批准的最常用于治疗肥胖的药物，描述了它们的作用机制，以及最近研究中这些药物的疗效和安全性，特别是在 CVD 患者中的研究。
在肥胖和 CVD 患者群体中，就安全性而言，奥利司他、lorcaserin 和利拉鲁肽等药物被认为是最适合治疗肥胖的药物。在这组患者中，应避免使用拟交感神经药物，如苯丙醇胺。最近的 CAMELLIA-TIMI 61 试验支持 lorcaserin 在 CVD 患者中的安全性。在 LEADER 试验发现接受利拉鲁肽治疗的 2 型糖尿病患者心血管结局改善的结果外推到正在接受肥胖治疗的非糖尿病患者之前，还需要更多的心血管结局试验（CVOT）来评估其他减肥药物治疗选择的安全性。
