Sibutramine use linked to improved lipid profiles in obese patients


By Anthony J. Brown, MD

WESTPORT, CT (Reuters Health) – A report published in the September issue of the American Heart Journal suggests that sibutramine can improve the lipid profile of obese patients who have elevated serum triglyceride and decreased HDL cholesterol (HDL-C) levels.

Dr. Carlos A. Dujovne, from Radiant Research in Overland Park, Kansas, and colleagues assessed the lipid effects of sibutramine in 322 dyslipidemic obese patients. The subjects were placed on a step I American Heart Association diet and randomized to receive sibutramine 20 mg or placebo once daily for 24 weeks.

On average, sibutramine-treated patients lost 4.9 kg, while control patients only lost 0.6 kg, the authors note. Sibutramine-treated subjects who lost 5% or more of their baseline weight achieved significant improvements in triglyceride and HDL-C levels compared with levels of control subjects. Discontinuation rates and adverse events were similar in both groups, but silbutramine use was associated with a slight increase in blood pressure.

"This article highlights the fact that obesity is one of the major causes of low HDL," Dr. Dujovne told Reuters Health. "It also shows that by lowering weight, the HDL level increases, and the patient's heart disease risk decreases," he added.

"Silbutramine was initially tested as an antidepressant against fluoxetine," Dr. Dujovne pointed out. "During testing, it was found that both medications produced weight loss, but the effect was stronger with silbutramine," he said. "Obese patients are often depressed, so using silbutramine in this population is really like killing two birds with one stone," he added.

In an accompanying editorial, Drs. Manesh R. Patel and Darren K. McGuire, from Duke University in Durham, North Carolina, comment that, assuming silbutramine is safe, three major questions remain regarding treatment of obesity.

It needs to be determined whether weight loss actually decreases the incidence of adverse events, such as myocardial infarction or stroke, in these patients, the editorialists note. Secondly, the results of obesity studies, with their highly selected patient populations and controlled settings, may not be useful for practicing physicians. Finally, it is unclear if treatment for obesity should be the main objective rather than prevention.

Am Heart J 2001;142:388-390,489-497.

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