Risk for valvular heart disease among users of fenfluramine and dexfenfluramine who underwent echocardiography before use of medication.

BACKGROUND

Because uncontrolled echocardiographic surveys suggested that up to 30% to 38% of users of fenfluramine and dexfenfluramine had valvular disease, these drugs were withdrawn from the market.

OBJECTIVE

To determine the risk for new or worsening valvular abnormalities among users of fenfluramine or dexfenfluramine who underwent echocardiography before they began to take these medications.

DESIGN

Cohort study.

SETTING

Academic primary care practices.

PATIENTS

46 patients who used fenfluramine or dexfenfluramine for 14 days or more and had echocardiograms obtained before therapy.

MEASUREMENTS

Follow-up echocardiography. The primary outcome was new or worsening valvulopathy, defined as progression of either aortic or mitral regurgitation by at least one degree of severity and disease that met U.S. Food and Drug Administration criteria (at least mild aortic regurgitation or moderate mitral regurgitation).

RESULTS

Two patients (4.3% [95% CI, 0.6% to 14.8%]) receiving fenfluramine-phentermine developed valvular heart disease. One had baseline bicuspid aortic valve and mild aortic regurgitation that progressed to moderate regurgitation. The second patient developed new moderate aortic insufficiency.

CONCLUSION

Users of diet medications are at risk for valvular heart disease. However, the incidence may be lower than that reported previously.