Pharmacotherapy for weight loss: the cardiovascular effects of the old and new agents.

WHAT IS KNOWN AND OBJECTIVE Obesity affects approximately one-third of the American population, and its prevalence continues to increase. It is a significant risk factor for cardiovascular diseases and contributes to increased healthcare costs and mortality. The objective is to review the current literature on the cardiovascular effects of weight loss pharmacotherapy agents. METHODS Literature was accessed through MEDLINE/PubMed (up to April 2013) using the search terms obesity, weight loss, pharmacotherapy, cardiovascular adverse effects and cardiovascular side effects. References of the articles identified and www.clinicaltrials.gov were also reviewed. Relevant guidelines, review articles, clinical trials, meta-analyses, case series, FDA documentation and prescribing information were included and limited to English language articles. RESULTS AND DISCUSSION With the newly FDA-approved weight loss pharmacotherapy, treatment options for obesity are more diverse. However, safety concerns, including adverse cardiovascular effects, have played a significant role in the history of weight loss pharmacotherapy and will likely play a role in the future of the new agents, lorcaserin and phentermine/topiramate, as well. WHAT IS NEW AND CONCLUSION Long-term cardiovascular outcomes studies with and without high-risk cardiovascular patients are still needed for both lorcaserin and phentermine/topiramate before these agents can be recommended in these patient populations. It is yet to be determined whether modest weight loss benefit of these new agents outweighs the cardiovascular risks.