Childhood Body-Mass Index and the Risk of Coronary Heart Disease in Adulthood
New England Journal of Medicine
December 6, 2007
Jennifer L. Baker, Ph.D., Lina W. Olsen, Ph.D., and Thorkild I.A. Sørensen, M.D., Dr.Med.Sci.
ABSTRACT
Background The worldwide epidemic of childhood obesity is progressing at an alarming rate. Risk factors for coronary heart disease (CHD) are already identifiable in overweight children. The severity of the long-term effects of excess childhood weight on CHD, however, remains unknown.
Methods We investigated the association between body-mass index (BMI) in childhood (7 through 13 years of age) and CHD in adulthood (25 years of age or older), with and without adjustment for birth weight. The subjects were a cohort of 276,835 Danish schoolchildren for whom measurements of height and weight were available. CHD events were ascertained by linkage to national registers. Cox regression analyses were performed.
Results In 5,063,622 person-years of follow-up, 10,235 men and 4318 women for whom childhood BMI data were available received a diagnosis of CHD or died of CHD as adults. The risk of any CHD event, a nonfatal event, and a fatal event among adults was positively associated with BMI at 7 to 13 years of age for boys and 10 to 13 years of age for girls. The associations were linear for each age, and the risk increased across the entire BMI distribution. Furthermore, the risk increased as the age of the child increased. Adjustment for birth weight strengthened the results.
Conclusions Higher BMI during childhood is associated with an increased risk of CHD in adulthood. The associations are stronger in boys than in girls and increase with the age of the child in both sexes. Our findings suggest that as children are becoming heavier worldwide, greater numbers of them are at risk of having CHD in adulthood
Showing posts with label Obesity. Show all posts
Showing posts with label Obesity. Show all posts
Thursday, December 6, 2007
Friday, November 16, 2007
Obesity Paradox in Patients with Hypertension and Coronary Artery Disease
Obesity Paradox in Patients with Hypertension and Coronary Artery Disease
The American Journal of Medicine
Volume 120, Issue 10, October 2007, Pages 863-870
Abstract
Purpose
An obesity paradox, a “paradoxical” decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with hypertension and coronary artery disease is not known.
Methods
A total of 22,576 hypertensive patients with coronary artery disease (follow-up 61,835 patient years, mean age 66 ± 9.8 years) were randomized to a verapamil-SR or atenolol strategy. Dose titration and additional drugs (trandolapril and/or hydrochlorothiazide) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure targets. Patients were classified into 5 groups according to baseline BMI: less than 20 kg/m2 (thin), 20 to 25 kg/m2 (normal weight), 25 to 30 kg/m2 (overweight), 30 to 35 kg/m2 (class I obesity), and 35 kg/m2 or more (class II-III obesity). The primary outcome was first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke.
Results
With patients of normal weight (BMI 20 to <25 kg/m2) as the reference group, the risk of primary outcome was lower in the overweight patients (adjusted hazard ratio [HR] 0.77, 95% confidence interval [CI], 0.70-0.86, P <.001), class I obese patients (adjusted HR 0.68, 95% CI, 0.59-0.78, P <.001), and class II to III obese patients (adjusted HR 0.76, 95% CI, 0.65-0.88, P <.001). Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months (−17.5 ± 21.9 mm Hg/−9.8 ± 12.4 mm Hg vs −20.7 ± 23.1 mm Hg /−10.6 ± 12.5 mm Hg, P <.001).
Conclusion
In a population with hypertension and coronary artery disease, overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight, which was driven primarily by a decreased risk of all-cause mortality. Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention.
The American Journal of Medicine
Volume 120, Issue 10, October 2007, Pages 863-870
Abstract
Purpose
An obesity paradox, a “paradoxical” decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with hypertension and coronary artery disease is not known.
Methods
A total of 22,576 hypertensive patients with coronary artery disease (follow-up 61,835 patient years, mean age 66 ± 9.8 years) were randomized to a verapamil-SR or atenolol strategy. Dose titration and additional drugs (trandolapril and/or hydrochlorothiazide) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure targets. Patients were classified into 5 groups according to baseline BMI: less than 20 kg/m2 (thin), 20 to 25 kg/m2 (normal weight), 25 to 30 kg/m2 (overweight), 30 to 35 kg/m2 (class I obesity), and 35 kg/m2 or more (class II-III obesity). The primary outcome was first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke.
Results
With patients of normal weight (BMI 20 to <25 kg/m2) as the reference group, the risk of primary outcome was lower in the overweight patients (adjusted hazard ratio [HR] 0.77, 95% confidence interval [CI], 0.70-0.86, P <.001), class I obese patients (adjusted HR 0.68, 95% CI, 0.59-0.78, P <.001), and class II to III obese patients (adjusted HR 0.76, 95% CI, 0.65-0.88, P <.001). Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months (−17.5 ± 21.9 mm Hg/−9.8 ± 12.4 mm Hg vs −20.7 ± 23.1 mm Hg /−10.6 ± 12.5 mm Hg, P <.001).
Conclusion
In a population with hypertension and coronary artery disease, overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight, which was driven primarily by a decreased risk of all-cause mortality. Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention.
Long term pharmacotherapy for obesity and overweight: updated meta-analysis
Long term pharmacotherapy for obesity and overweight: updated meta-analysis -- Rucker et al., 10.1136/bmj.39385.413113.25 -- BMJ
Abstract
Objective To summarise the long term efficacy of anti-obesity drugs in reducing weight and improving health status.
Design Updated meta-analysis of randomised trials.
Data sources Medline, Embase, the Cochrane controlled trials register, the Current Science meta-register of controlled trials, and reference lists of identified articles. All data sources were searched from December 2002 (end date of last search) to December 2006.
Studies reviewed Double blind randomised placebo controlled trials of approved anti-obesity dugs used in adults (age over 18) for one year or longer.
Results 30 trials of one to four years' duration met the inclusion criteria: 16 orlistat (n=10 631 participants), 10 sibutramine (n=2623), and four rimonabant (n=6365). Of these, 14 trials were new and 16 had previously been identified. Attrition rates averaged 30-40%. Compared with placebo, orlistat reduced weight by 2.9 kg (95% confidence interval 2.5 kg to 3.2 kg), sibutramine by 4.2 kg (3.6 kg to 4.7 kg), and rimonabant by 4.7 kg (4.1 kg to 5.3 kg). Patients receiving active drug treatment were significantly more likely to achieve 5% and 10% weight loss thresholds. Orlistat reduced the incidence of diabetes and improved concentrations of total cholesterol and low density lipoprotein cholesterol, blood pressure, and glycaemic control in patients with diabetes but increased rates of gastrointestinal side effects and slightly lowered concentrations of high density lipoprotein. Sibutramine lowered concentrations of high density lipoprotein cholesterol and triglycerides but raised blood pressure and pulse rate. Rimonabant improved concentrations of high density lipoprotein cholesterol and triglycerides, blood pressure, and glycaemic control in patients with diabetes but increased the risk of mood disorders.
Conclusions Orlistat, sibutramine, and rimonabant modestly reduce weight, have differing effects on cardiovascular risk profiles, and have specific adverse effects.
Abstract
Objective To summarise the long term efficacy of anti-obesity drugs in reducing weight and improving health status.
Design Updated meta-analysis of randomised trials.
Data sources Medline, Embase, the Cochrane controlled trials register, the Current Science meta-register of controlled trials, and reference lists of identified articles. All data sources were searched from December 2002 (end date of last search) to December 2006.
Studies reviewed Double blind randomised placebo controlled trials of approved anti-obesity dugs used in adults (age over 18) for one year or longer.
Results 30 trials of one to four years' duration met the inclusion criteria: 16 orlistat (n=10 631 participants), 10 sibutramine (n=2623), and four rimonabant (n=6365). Of these, 14 trials were new and 16 had previously been identified. Attrition rates averaged 30-40%. Compared with placebo, orlistat reduced weight by 2.9 kg (95% confidence interval 2.5 kg to 3.2 kg), sibutramine by 4.2 kg (3.6 kg to 4.7 kg), and rimonabant by 4.7 kg (4.1 kg to 5.3 kg). Patients receiving active drug treatment were significantly more likely to achieve 5% and 10% weight loss thresholds. Orlistat reduced the incidence of diabetes and improved concentrations of total cholesterol and low density lipoprotein cholesterol, blood pressure, and glycaemic control in patients with diabetes but increased rates of gastrointestinal side effects and slightly lowered concentrations of high density lipoprotein. Sibutramine lowered concentrations of high density lipoprotein cholesterol and triglycerides but raised blood pressure and pulse rate. Rimonabant improved concentrations of high density lipoprotein cholesterol and triglycerides, blood pressure, and glycaemic control in patients with diabetes but increased the risk of mood disorders.
Conclusions Orlistat, sibutramine, and rimonabant modestly reduce weight, have differing effects on cardiovascular risk profiles, and have specific adverse effects.
Monday, November 12, 2007
Rethinking a “healthy weight”: New study finds that being overweight is not associated with increased mortality from cardiovascular causes
Rethinking a “healthy weight”: New study finds that being overweight is not associated with increased mortality from cardiovascular causes
November 9, 2007 By Benjamin A. Olenchock, M.D. Ph.D.
Bethesda, MD
A new study has examined disease-specific mortality rates based on body mass index (BMI) using data from the National Health and Nutrition Examination Survey (NHANES) databases.
The findings, published in the Journal of the American Medical Association, suggest that individuals defined as overweight (BMI between 25 and 30) do not have increased cardiovascular mortality. Obesity (BMI > 30), however, was associated with excess cardiovascular mortality, although to a much lesser extent than in previous years. Under-weight (BMI<18.5) was associated with higher non-CVD/non-cancer mortality. This research is a continuation of work published in 2005 that examined all-cause mortality.
The previous study reported that over-weight individuals had decreased all-cause mortality compared to normal weight individuals, while obesity and under-weight were found to have increased all-cause mortality.
The statistical analyses required to do such a study were quite complex. The study used the NHANES databases to gather baseline data in representative cross-sectional samples of the United States population. Cause of death was divided into three categories: cardiovascular, cancer, and all other. They used a Cox proportional hazard model to calculate the relative disease-specific risk for the different BMI classes, separating the analysis by age for statistical reasons. The model included sex, smoking status, race, and alcohol consumptions as other covariates. To estimate the excess disease-specific mortality in 2004 attributable to BMI class, they applied their relative risk data to mortality data from the United States vital statistics in 2004, estimating the current distribution of covariates using the NHANES 1999-2002 cross-sectional data set.
Obesity was associated with 81,072 [CI 51,433 to 110,710] excess deaths from cardiovascular disease but no statistically significant increase in cancer deaths (14,930, [CI -13,721 to 43,582]). Obesity was, however, associated with increased obesity-related cancers, defined as colon, breast, esophageal, uterine, ovarian, kidney and pancreatic (13,839 excess deaths, CI 1920 to 25,758). The authors analyzed longitudinal changes in attributable deaths by using relative risk estimates for individual NHANES databases. They found that using NHANES I (1971-1975) relative risk estimates, obesity was associated with 161,290 excess deaths from cardiovascular causes, much more than the current estimate of 81,072.
Overweight was associated with no excess deaths from cardiovascular causes (-17,074, CI -50,407 to 16,259) or cancer (-13,533, CI -44364 to 17298), but significantly decreased deaths from all-other causes (-107674, CI -148738 to -66610). Underweight, in contrast, was associated with excess deaths from all-other causes (23,455, CI 11,848 to 35,061). Looking closer at the over-weight category, the authors did find that both overweight and obese individuals had excess deaths from kidney disease and diabetes.
This data adds significantly to their previous work, which demonstrated differences in all-cause mortality based on BMI. One interesting finding is that over-weight is associated with less all-cause mortality and no difference in cardiovascular mortality. Also, the data are notable for the apparent change in the excess cardiovascular deaths associated with obesity over time, perhaps reflecting improvements in medical care in recent years. These data are sure to bring commentaries on the statistical methods used, changes in BMI class over time as a consequence rather than cause of disease, concerns about cause of death reporting bias, etc. Nonetheless, this work is an important contribution to our current understanding of healthy body weight and the relationship between cardiovascular disease mortality and excess body weight.
November 9, 2007 By Benjamin A. Olenchock, M.D. Ph.D.
Bethesda, MD
A new study has examined disease-specific mortality rates based on body mass index (BMI) using data from the National Health and Nutrition Examination Survey (NHANES) databases.
The findings, published in the Journal of the American Medical Association, suggest that individuals defined as overweight (BMI between 25 and 30) do not have increased cardiovascular mortality. Obesity (BMI > 30), however, was associated with excess cardiovascular mortality, although to a much lesser extent than in previous years. Under-weight (BMI<18.5) was associated with higher non-CVD/non-cancer mortality. This research is a continuation of work published in 2005 that examined all-cause mortality.
The previous study reported that over-weight individuals had decreased all-cause mortality compared to normal weight individuals, while obesity and under-weight were found to have increased all-cause mortality.
The statistical analyses required to do such a study were quite complex. The study used the NHANES databases to gather baseline data in representative cross-sectional samples of the United States population. Cause of death was divided into three categories: cardiovascular, cancer, and all other. They used a Cox proportional hazard model to calculate the relative disease-specific risk for the different BMI classes, separating the analysis by age for statistical reasons. The model included sex, smoking status, race, and alcohol consumptions as other covariates. To estimate the excess disease-specific mortality in 2004 attributable to BMI class, they applied their relative risk data to mortality data from the United States vital statistics in 2004, estimating the current distribution of covariates using the NHANES 1999-2002 cross-sectional data set.
Obesity was associated with 81,072 [CI 51,433 to 110,710] excess deaths from cardiovascular disease but no statistically significant increase in cancer deaths (14,930, [CI -13,721 to 43,582]). Obesity was, however, associated with increased obesity-related cancers, defined as colon, breast, esophageal, uterine, ovarian, kidney and pancreatic (13,839 excess deaths, CI 1920 to 25,758). The authors analyzed longitudinal changes in attributable deaths by using relative risk estimates for individual NHANES databases. They found that using NHANES I (1971-1975) relative risk estimates, obesity was associated with 161,290 excess deaths from cardiovascular causes, much more than the current estimate of 81,072.
Overweight was associated with no excess deaths from cardiovascular causes (-17,074, CI -50,407 to 16,259) or cancer (-13,533, CI -44364 to 17298), but significantly decreased deaths from all-other causes (-107674, CI -148738 to -66610). Underweight, in contrast, was associated with excess deaths from all-other causes (23,455, CI 11,848 to 35,061). Looking closer at the over-weight category, the authors did find that both overweight and obese individuals had excess deaths from kidney disease and diabetes.
This data adds significantly to their previous work, which demonstrated differences in all-cause mortality based on BMI. One interesting finding is that over-weight is associated with less all-cause mortality and no difference in cardiovascular mortality. Also, the data are notable for the apparent change in the excess cardiovascular deaths associated with obesity over time, perhaps reflecting improvements in medical care in recent years. These data are sure to bring commentaries on the statistical methods used, changes in BMI class over time as a consequence rather than cause of disease, concerns about cause of death reporting bias, etc. Nonetheless, this work is an important contribution to our current understanding of healthy body weight and the relationship between cardiovascular disease mortality and excess body weight.
Thursday, October 18, 2007
Obese children show early signs of heart disease
Obese children show early signs of heart disease
Oct. 16, 2007 -- Children who are obese or who are at risk for obesity show early signs of heart disease similar to obese adults with heart disease, a study by researchers at Washington University School of Medicine in St. Louis has found.
"Based on this study, these subtle markers can help us predict who could be at risk for heart disease and heart attacks," said Angela Sharkey, M.D., associate professor of pediatrics at Washington University School of Medicine and a pediatric cardiologist at St. Louis Children's Hospital.
The study was published in the Winter 2007 issue of the Journal of Cardiometabolic Syndrome
Childhood obesity in the United States is an epidemic — nationwide, 19 percent of children ages 6 to 11 and 17 percent of those 12 to 19 are overweight, according to the Centers for Disease Control and Prevention (CDC). Those who are overweight during childhood also have an increased risk of obesity in adulthood and are at greater risk for complications such as diabetes, high blood pressure and heart disease, because obesity increases total blood volume, which leads to extra stress on the heart.
Sharkey and Steven M. Lorch, M.D., a former fellow at the School of Medicine now at University of Texas Health Science Center at Houston, analyzed data from 168 children ages 10 to 18 who had been referred to them for cardiac ultrasound with symptoms including heart murmur, chest pain, acid reflux or high blood cholesterol. Based on CDC guidelines for body mass index for age (BMIA), 33 patients were found to have a BMIA as obese, or the 95th percentile or above for their age; 20 had a BMIA that classified them as at risk for obesity, or between the 85th and 94th percentile; and 115 were considered normal, or below the 85th percentile.
To analyze the hearts of the obese children and those at risk, Sharkey and Lorch used a new tissue Doppler imaging technique called vector velocity imaging which tracks the movement of the heart's muscular wall. Any changes in the rate of motion of heart muscle were averaged within each group and compared to the normal rate of motion.
"In the patients who are obese, the rate of motion of heart muscle changed," Sharkey said. "As a child's BMIA increases, we see alterations in both the relaxation and contraction phase of the heartbeat. Many of these changes that have been seen in adults were assumed to be from long-standing obesity, but it may be that these changes start much earlier in life than we thought."
As vector velocity imaging becomes more broadly available, Sharkey said, it could potentially help pediatric cardiologists follow these children more closely over time to see if changes in the heart progress.
"We may be able to determine whether we could intervene in the process, such as focusing the families on understanding the importance of regular exercise and dietary modifications for weight loss and prescribing statin drugs for high-blood cholesterol," she said.
Sharkey said the results of the study give more ammunition to physicians to use in counseling pediatric patients and their parents about the risks of obesity and the need to attain a healthy weight.
"Even in teenagers, obesity leads to decreased myocardial performance and abnormal diastolic function," she said.
Further study is needed to determine how soon the changes in the heart set in after a child becomes obese and whether those changes are reversible with weight loss.
Lorch SM, Sharkey A. Myocardial Velocity, Strain, and Strain Rate Abnormalities in Healthy Obese Children. Journal of Cardiometabolic Syndrome. 2007 Winter; 2(1):30-4.
Oct. 16, 2007 -- Children who are obese or who are at risk for obesity show early signs of heart disease similar to obese adults with heart disease, a study by researchers at Washington University School of Medicine in St. Louis has found.
"Based on this study, these subtle markers can help us predict who could be at risk for heart disease and heart attacks," said Angela Sharkey, M.D., associate professor of pediatrics at Washington University School of Medicine and a pediatric cardiologist at St. Louis Children's Hospital.
The study was published in the Winter 2007 issue of the Journal of Cardiometabolic Syndrome
Childhood obesity in the United States is an epidemic — nationwide, 19 percent of children ages 6 to 11 and 17 percent of those 12 to 19 are overweight, according to the Centers for Disease Control and Prevention (CDC). Those who are overweight during childhood also have an increased risk of obesity in adulthood and are at greater risk for complications such as diabetes, high blood pressure and heart disease, because obesity increases total blood volume, which leads to extra stress on the heart.
Sharkey and Steven M. Lorch, M.D., a former fellow at the School of Medicine now at University of Texas Health Science Center at Houston, analyzed data from 168 children ages 10 to 18 who had been referred to them for cardiac ultrasound with symptoms including heart murmur, chest pain, acid reflux or high blood cholesterol. Based on CDC guidelines for body mass index for age (BMIA), 33 patients were found to have a BMIA as obese, or the 95th percentile or above for their age; 20 had a BMIA that classified them as at risk for obesity, or between the 85th and 94th percentile; and 115 were considered normal, or below the 85th percentile.
To analyze the hearts of the obese children and those at risk, Sharkey and Lorch used a new tissue Doppler imaging technique called vector velocity imaging which tracks the movement of the heart's muscular wall. Any changes in the rate of motion of heart muscle were averaged within each group and compared to the normal rate of motion.
"In the patients who are obese, the rate of motion of heart muscle changed," Sharkey said. "As a child's BMIA increases, we see alterations in both the relaxation and contraction phase of the heartbeat. Many of these changes that have been seen in adults were assumed to be from long-standing obesity, but it may be that these changes start much earlier in life than we thought."
As vector velocity imaging becomes more broadly available, Sharkey said, it could potentially help pediatric cardiologists follow these children more closely over time to see if changes in the heart progress.
"We may be able to determine whether we could intervene in the process, such as focusing the families on understanding the importance of regular exercise and dietary modifications for weight loss and prescribing statin drugs for high-blood cholesterol," she said.
Sharkey said the results of the study give more ammunition to physicians to use in counseling pediatric patients and their parents about the risks of obesity and the need to attain a healthy weight.
"Even in teenagers, obesity leads to decreased myocardial performance and abnormal diastolic function," she said.
Further study is needed to determine how soon the changes in the heart set in after a child becomes obese and whether those changes are reversible with weight loss.
Lorch SM, Sharkey A. Myocardial Velocity, Strain, and Strain Rate Abnormalities in Healthy Obese Children. Journal of Cardiometabolic Syndrome. 2007 Winter; 2(1):30-4.
Monday, October 8, 2007
Obesity Paradox in Patients with Hypertension and Coronary Artery Disease
Obesity Paradox in Patients with Hypertension and Coronary Artery Disease
The American Journal of Medicine
Volume 120, Issue 10, Pages 825-918 (October 2007)
Abstract
Purpose
An obesity paradox, a “paradoxical” decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with hypertension and coronary artery disease is not known.
Methods
A total of 22,576 hypertensive patients with coronary artery disease (follow-up 61,835 patient years, mean age 66±9.8 years) were randomized to a verapamil-SR or atenolol strategy. Dose titration and additional drugs (trandolapril and/or hydrochlorothiazide) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure targets. Patients were classified into 5 groups according to baseline BMI: less than 20 kg/m2 (thin), 20 to 25 kg/m2 (normal weight), 25 to 30 kg/m2 (overweight), 30 to 35 kg/m2 (class I obesity), and 35 kg/m2 or more (class II-III obesity). The primary outcome was first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke.
Results
With patients of normal weight (BMI 20 to<25 kg/m2) as the reference group, the risk of primary outcome was lower in the overweight patients (adjusted hazard ratio [HR] 0.77, 95% confidence interval [CI], 0.70-0.86, P<.001), class I obese patients (adjusted HR 0.68, 95% CI, 0.59-0.78, P<.001), and class II to III obese patients (adjusted HR 0.76, 95% CI, 0.65-0.88, P <.001). Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months (−17.5±21.9 mm Hg/−9.8±12.4 mm Hg vs −20.7±23.1 mm Hg /−10.6±12.5 mm Hg, P<.001).
Conclusion
In a population with hypertension and coronary artery disease, overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight, which was driven primarily by a decreased risk of all-cause mortality. Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention.
Study Limitations
This was a post hoc analysis and thus suffers from the limitations of such studies. Our conclusions should be considered to be hypothesis generating. The INVEST did not collect the waist-to-hip ratio data; therefore, we could not compare BMI with waist-to-hip ratio. Although we did find differences in the primary and secondary outcomes between BMI groups, the baseline characteristics of the BMI categories were not well matched. Although a stepwise model was used, the impact of these baseline differences cannot be ruled out.
The American Journal of Medicine
Volume 120, Issue 10, Pages 825-918 (October 2007)
Abstract
Purpose
An obesity paradox, a “paradoxical” decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients with heart failure and those undergoing percutaneous coronary intervention. However, whether this phenomenon exists in patients with hypertension and coronary artery disease is not known.
Methods
A total of 22,576 hypertensive patients with coronary artery disease (follow-up 61,835 patient years, mean age 66±9.8 years) were randomized to a verapamil-SR or atenolol strategy. Dose titration and additional drugs (trandolapril and/or hydrochlorothiazide) were added to achieve target blood pressure control according to the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure targets. Patients were classified into 5 groups according to baseline BMI: less than 20 kg/m2 (thin), 20 to 25 kg/m2 (normal weight), 25 to 30 kg/m2 (overweight), 30 to 35 kg/m2 (class I obesity), and 35 kg/m2 or more (class II-III obesity). The primary outcome was first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke.
Results
With patients of normal weight (BMI 20 to<25 kg/m2) as the reference group, the risk of primary outcome was lower in the overweight patients (adjusted hazard ratio [HR] 0.77, 95% confidence interval [CI], 0.70-0.86, P<.001), class I obese patients (adjusted HR 0.68, 95% CI, 0.59-0.78, P<.001), and class II to III obese patients (adjusted HR 0.76, 95% CI, 0.65-0.88, P <.001). Class I obese patients had the lowest rate of primary outcome and death despite having smaller blood pressure reduction compared with patients of normal weight at 24 months (−17.5±21.9 mm Hg/−9.8±12.4 mm Hg vs −20.7±23.1 mm Hg /−10.6±12.5 mm Hg, P<.001).
Conclusion
In a population with hypertension and coronary artery disease, overweight and obese patients had a decreased risk of primary outcome compared with patients of normal weight, which was driven primarily by a decreased risk of all-cause mortality. Our results further suggest a protective effect of obesity in patients with known cardiovascular disease in concordance with data in patients with heart failure and those undergoing percutaneous coronary intervention.
Study Limitations
This was a post hoc analysis and thus suffers from the limitations of such studies. Our conclusions should be considered to be hypothesis generating. The INVEST did not collect the waist-to-hip ratio data; therefore, we could not compare BMI with waist-to-hip ratio. Although we did find differences in the primary and secondary outcomes between BMI groups, the baseline characteristics of the BMI categories were not well matched. Although a stepwise model was used, the impact of these baseline differences cannot be ruled out.
Tuesday, October 2, 2007
Weight Loss Can Normalize Blood Pressure
AHA-BP: Weight Loss Can Normalize Blood Pressure
By Charles Bankhead, Staff Writer, MedPage TodayReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.October 01, 2007
MedPage Today Action Points
Explain to interested patients that weight loss alone may help lower blood pressure to normal levels in some overweight individuals with stage I hypertension.
The results were reported at a medical conference and as a published abstract and should be considered preliminary until published in a peer-reviewed journal.
Review
TUCSON, Ariz., Oct. 1 -- At least half of overweight patients with stage I hypertension can normalize their blood pressure with modest weight loss, Italian investigators reported here.
After six months on a reduced-calorie diet, supplemented by a lipase inhibitor in some cases, about half of 210 patients lost more than 5% of their body weight, which was associated with about a 5% reduction in blood pressure, Roberto Fogari, M.D., of the University of Pavia, reported at a conference of the American Heart Association's Council for High Blood Pressure Research.
The results demonstrated not only that weight loss alone can normalize hypertension but also that many overweight hypertensive patients have been misdiagnosed as having essential hypertension. The results emphasize the importance of initiating dietary intervention in overweight patients with high blood pressure before resorting to drug treatment, said Dr. Fogari.
"This is important because it means that in these patients with elevated blood pressure who were overweight, the blood pressure is not a form of essential hypertension but was hypertension secondary to body weight," said Dr. Fogari.
"These findings apply to western societies in general, but only to overweight patients, not to obese patients, with high blood pressure," he added.
The study involved men and women ages 29 to 65 and who had a body mass index of 25 to 29 kg/m2, defining them as overweight but not obese. All the patients had stage I hypertension, reflected in a systolic blood pressure of 140 to 159 mm Hg and a diastolic pressure of 90 to 99 mm Hg. None of the patients had a history of antihypertensive therapy.
Upon entry to the study, each patient consulted with dietary authorities who developed individualized reduced-calorie food plans that reflected a patient's food preferences. About half the patients also received the lipase inhibitor orilistat (Xenical) as an aid to weight loss and weight maintenance.
"We gave orilistat only when diet alone was not able to achieve the appropriate reduction in body weight," said Dr. Fogari.
After six months of follow-up, 49% of the women and 53% of the men had lost more than 5% of the baseline bodyweight. The 5% reduction in blood pressure that accompanied the weight loss was sufficient to normalize blood pressure in many patients.
There was a significant reduction in plasma leptin (from 17.3±4.4 to 10.9±3.2 ng/mL, P<0.01), active renin (from 12.9±6.8 to 9.1±5.2 pg/mL P<0.05), and aldosterone (from 71.8±28.4 to 59.7±23.5 P<0.01).
Forty-eight percent of the those with bodyweight loss of 5% or more achieved a normal BMI (< 25 Kg/m2) and 53% showed a BP blood pressure normalization (< 140/90 mmHg). Plasma leptin, active renin and aldosterone decreases were not different than those of the 25 patients who did not achieve the blood pressure normalization despite the BMI normalization.
The study will continue until all patients have been followed for a year.
Primary source: American Heart Association's 61st Annual Fall Conference of the Council on High Blood Pressure Research
Source reference:
Fogari R et al. "Effect of body weight loss on blood pressure in stage I hypertensive overweight patients. American Heart Association's 61st Fall Conference of the Council on High Blood Pressure Research, 2007. Abstract P213.
By Charles Bankhead, Staff Writer, MedPage TodayReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.October 01, 2007
MedPage Today Action Points
Explain to interested patients that weight loss alone may help lower blood pressure to normal levels in some overweight individuals with stage I hypertension.
The results were reported at a medical conference and as a published abstract and should be considered preliminary until published in a peer-reviewed journal.
Review
TUCSON, Ariz., Oct. 1 -- At least half of overweight patients with stage I hypertension can normalize their blood pressure with modest weight loss, Italian investigators reported here.
After six months on a reduced-calorie diet, supplemented by a lipase inhibitor in some cases, about half of 210 patients lost more than 5% of their body weight, which was associated with about a 5% reduction in blood pressure, Roberto Fogari, M.D., of the University of Pavia, reported at a conference of the American Heart Association's Council for High Blood Pressure Research.
The results demonstrated not only that weight loss alone can normalize hypertension but also that many overweight hypertensive patients have been misdiagnosed as having essential hypertension. The results emphasize the importance of initiating dietary intervention in overweight patients with high blood pressure before resorting to drug treatment, said Dr. Fogari.
"This is important because it means that in these patients with elevated blood pressure who were overweight, the blood pressure is not a form of essential hypertension but was hypertension secondary to body weight," said Dr. Fogari.
"These findings apply to western societies in general, but only to overweight patients, not to obese patients, with high blood pressure," he added.
The study involved men and women ages 29 to 65 and who had a body mass index of 25 to 29 kg/m2, defining them as overweight but not obese. All the patients had stage I hypertension, reflected in a systolic blood pressure of 140 to 159 mm Hg and a diastolic pressure of 90 to 99 mm Hg. None of the patients had a history of antihypertensive therapy.
Upon entry to the study, each patient consulted with dietary authorities who developed individualized reduced-calorie food plans that reflected a patient's food preferences. About half the patients also received the lipase inhibitor orilistat (Xenical) as an aid to weight loss and weight maintenance.
"We gave orilistat only when diet alone was not able to achieve the appropriate reduction in body weight," said Dr. Fogari.
After six months of follow-up, 49% of the women and 53% of the men had lost more than 5% of the baseline bodyweight. The 5% reduction in blood pressure that accompanied the weight loss was sufficient to normalize blood pressure in many patients.
There was a significant reduction in plasma leptin (from 17.3±4.4 to 10.9±3.2 ng/mL, P<0.01), active renin (from 12.9±6.8 to 9.1±5.2 pg/mL P<0.05), and aldosterone (from 71.8±28.4 to 59.7±23.5 P<0.01).
Forty-eight percent of the those with bodyweight loss of 5% or more achieved a normal BMI (< 25 Kg/m2) and 53% showed a BP blood pressure normalization (< 140/90 mmHg). Plasma leptin, active renin and aldosterone decreases were not different than those of the 25 patients who did not achieve the blood pressure normalization despite the BMI normalization.
The study will continue until all patients have been followed for a year.
Primary source: American Heart Association's 61st Annual Fall Conference of the Council on High Blood Pressure Research
Source reference:
Fogari R et al. "Effect of body weight loss on blood pressure in stage I hypertensive overweight patients. American Heart Association's 61st Fall Conference of the Council on High Blood Pressure Research, 2007. Abstract P213.
Tuesday, September 11, 2007
Traditional risk factors fail to explain over half of CHD risk in overweight people
Traditional risk factors fail to explain over half of CHD risk in overweight people
11 September 2007
MedWire News: Blood pressure and cholesterol levels explain less than half of the excess risk for coronary heart disease (CHD) in people who are overweight or obese, results of a meta-analysis suggest.
"This implies that, even under the theoretical scenario that optimal treatment would be available against hypertension and hypercholesterolemia in overweight persons, they still would have an elevated risk of CHD," say the researchers.
Writing in the Archives of Internal Medicine, Rik Bogers (National Institute for Public Health and the Environment, Bilthoven, The Netherlands) and colleagues list several mechanisms that could contribute to the increased CHD risk in overweight people.
These include low-grade inflammation, endothelial dysfunction, a tendency toward coagulation, and left ventricular hypertrophy.
"Obviously, overweight is associated with increased risk of Type 2 diabetes mellitus," they add.
The findings emerge from a collaborative meta-analysis involving investigators from 31 prospective cohort studies, including large studies such as the Nurses' Health Study, the Norwegian Counties Study, and the Whitehall Study.
This provided data on 302,296 people who suffered 18,000 CHD events. CHD risk was assessed in relation to body mass index (BMI) categories for 14 cohorts and in relation to BMI as a continuous variable for 21 cohorts.
Overweight people (BMI 25.0-29.9) had a relative risk for CHD of 1.32, compared with normal-weight people, after accounting for age, gender, physical activity, and smoking status.
The corresponding relative risk in obese people (BMI ≥30.0) was 1.81.
Accounting for blood pressure and cholesterol levels reduced the relative risks for CHD to 1.17 and 1.49 for overweight and obese people, respectively, compared with normal-weight people.
Thus, blood pressure and cholesterol levels accounted for 47% and 40% of the excess CHD risk associated with overweight and obesity, respectively.
Each 5-unit increase in BMI increased CHD risk 1.29 fold before accounting for blood pressure and cholesterol levels, and 1.16 fold after allowing for these risk factors.
"Even moderate overweight is associated with increased risk of CHD," the researchers stress.
"Because high blood pressure and cholesterol levels are plausible intermediary factors in the causal pathways linking overweight and CHD, adjusting for them in epidemiological analyses certainly results in underestimating the total public health impact of overweight."
Arch Intern Med 2007; 167: 1720-1728
11 September 2007
MedWire News: Blood pressure and cholesterol levels explain less than half of the excess risk for coronary heart disease (CHD) in people who are overweight or obese, results of a meta-analysis suggest.
"This implies that, even under the theoretical scenario that optimal treatment would be available against hypertension and hypercholesterolemia in overweight persons, they still would have an elevated risk of CHD," say the researchers.
Writing in the Archives of Internal Medicine, Rik Bogers (National Institute for Public Health and the Environment, Bilthoven, The Netherlands) and colleagues list several mechanisms that could contribute to the increased CHD risk in overweight people.
These include low-grade inflammation, endothelial dysfunction, a tendency toward coagulation, and left ventricular hypertrophy.
"Obviously, overweight is associated with increased risk of Type 2 diabetes mellitus," they add.
The findings emerge from a collaborative meta-analysis involving investigators from 31 prospective cohort studies, including large studies such as the Nurses' Health Study, the Norwegian Counties Study, and the Whitehall Study.
This provided data on 302,296 people who suffered 18,000 CHD events. CHD risk was assessed in relation to body mass index (BMI) categories for 14 cohorts and in relation to BMI as a continuous variable for 21 cohorts.
Overweight people (BMI 25.0-29.9) had a relative risk for CHD of 1.32, compared with normal-weight people, after accounting for age, gender, physical activity, and smoking status.
The corresponding relative risk in obese people (BMI ≥30.0) was 1.81.
Accounting for blood pressure and cholesterol levels reduced the relative risks for CHD to 1.17 and 1.49 for overweight and obese people, respectively, compared with normal-weight people.
Thus, blood pressure and cholesterol levels accounted for 47% and 40% of the excess CHD risk associated with overweight and obesity, respectively.
Each 5-unit increase in BMI increased CHD risk 1.29 fold before accounting for blood pressure and cholesterol levels, and 1.16 fold after allowing for these risk factors.
"Even moderate overweight is associated with increased risk of CHD," the researchers stress.
"Because high blood pressure and cholesterol levels are plausible intermediary factors in the causal pathways linking overweight and CHD, adjusting for them in epidemiological analyses certainly results in underestimating the total public health impact of overweight."
Arch Intern Med 2007; 167: 1720-1728
Wednesday, August 15, 2007
The Association of Differing Measures of Overweight and Obesity With Prevalent Atherosclerosis
The Association of Differing Measures of Overweight and Obesity With Prevalent Atherosclerosis
J Am Coll Cardiol, 2007; 50:752-759,
The Dallas Heart Study
Division of Cardiology, Department of Internal Medicine Donald W. Reynolds Cardiovascular Clinical Research Center, the University of Texas Southwestern Medical Center, Dallas, Texas
Manuscript received January 29, 2007; revised manuscript received March 23, 2007, accepted April 1, 2007.
Objectives: This study sought to evaluate the associations between different measures of obesity and prevalent atherosclerosis in a large population-based cohort.
Background: Although obesity is associated with cardiovascular mortality, it is unclear whether this relationship is mediated by increased atherosclerotic burden.
Methods: Using data from the Dallas Heart Study, we assessed the association between gender-specific obesity measures (i.e., body mass index [BMI]; waist circumference [WC]; waist-to-hip ratio [WHR]) and prevalent atherosclerosis defined as coronary artery calcium (CAC) score >10 Agatston units measured by electron-beam computed tomography and detectable aortic plaque measured by magnetic resonance imaging.
Results: In univariable analyses (n = 2,744), CAC prevalence was significantly greater only in the fifth versus first quintile of BMI, whereas it increased stepwise across quintiles of WC and WHR (p trend <0.001 for each). After multivariable adjustment for standard risk factors, prevalent CAC was more frequent in the fifth versus first quintile of WHR (odds ratio 1.91, 95% confidence interval 1.30 to 2.80), whereas no independent positive association was observed for BMI or WC. Similar results were observed for aortic plaque in both univariable and multivariable-adjusted analyses. The c-statistic for discrimination of prevalent CAC was greater for WHR compared with BMI and WC in women and men (p < 0.001 vs. BMI; p < 0.01 vs. WC).
Conclusions: We discovered that WHR was independently associated with prevalent atherosclerosis and provided better discrimination than either BMI or WC. The associations between obesity measurements and atherosclerosis mirror those observed between obesity and cardiovascular mortality, suggesting that obesity contributes to cardiovascular mortality via increased atherosclerotic burden.
J Am Coll Cardiol, 2007; 50:752-759,
The Dallas Heart Study
Division of Cardiology, Department of Internal Medicine Donald W. Reynolds Cardiovascular Clinical Research Center, the University of Texas Southwestern Medical Center, Dallas, Texas
Manuscript received January 29, 2007; revised manuscript received March 23, 2007, accepted April 1, 2007.
Objectives: This study sought to evaluate the associations between different measures of obesity and prevalent atherosclerosis in a large population-based cohort.
Background: Although obesity is associated with cardiovascular mortality, it is unclear whether this relationship is mediated by increased atherosclerotic burden.
Methods: Using data from the Dallas Heart Study, we assessed the association between gender-specific obesity measures (i.e., body mass index [BMI]; waist circumference [WC]; waist-to-hip ratio [WHR]) and prevalent atherosclerosis defined as coronary artery calcium (CAC) score >10 Agatston units measured by electron-beam computed tomography and detectable aortic plaque measured by magnetic resonance imaging.
Results: In univariable analyses (n = 2,744), CAC prevalence was significantly greater only in the fifth versus first quintile of BMI, whereas it increased stepwise across quintiles of WC and WHR (p trend <0.001 for each). After multivariable adjustment for standard risk factors, prevalent CAC was more frequent in the fifth versus first quintile of WHR (odds ratio 1.91, 95% confidence interval 1.30 to 2.80), whereas no independent positive association was observed for BMI or WC. Similar results were observed for aortic plaque in both univariable and multivariable-adjusted analyses. The c-statistic for discrimination of prevalent CAC was greater for WHR compared with BMI and WC in women and men (p < 0.001 vs. BMI; p < 0.01 vs. WC).
Conclusions: We discovered that WHR was independently associated with prevalent atherosclerosis and provided better discrimination than either BMI or WC. The associations between obesity measurements and atherosclerosis mirror those observed between obesity and cardiovascular mortality, suggesting that obesity contributes to cardiovascular mortality via increased atherosclerotic burden.
Thursday, July 26, 2007
Obesity Seems to Spread Through Social Networks
Obesity Seems to Spread Through Social Networks
Obesity appears to spread from person to person through social ties, according to a New England Journal of Medicine study.
The research evaluated a network of about 12,000 people over 32 years. All were members of the Framingham Heart Study. Researchers found, for example, that a person's chances of becoming obese increased by 57% in a given period if a friend became obese, 40% if a sibling did, and 37% if a spouse did. The effects were seen even if the obese acquaintance lived far away.
The authors speculate that someone who sees a friend gain weight may regard putting on weight as more acceptable. An editorialist says the work suggests that "friends have an even more important effect on a person's risk of obesity than genes do"
LINKS:
NEJM article (Free)
NEJM editorial (Free)
New York Times story (Free)
Obesity appears to spread from person to person through social ties, according to a New England Journal of Medicine study.
The research evaluated a network of about 12,000 people over 32 years. All were members of the Framingham Heart Study. Researchers found, for example, that a person's chances of becoming obese increased by 57% in a given period if a friend became obese, 40% if a sibling did, and 37% if a spouse did. The effects were seen even if the obese acquaintance lived far away.
The authors speculate that someone who sees a friend gain weight may regard putting on weight as more acceptable. An editorialist says the work suggests that "friends have an even more important effect on a person's risk of obesity than genes do"
LINKS:
NEJM article (Free)
NEJM editorial (Free)
New York Times story (Free)
Tuesday, July 3, 2007
Surprise Findings on Obesity and Heart Attacks
Patterns: In Studies, Surprise Findings on Obesity and Heart Attacks
Published: July 3, 2007
Two new studies shed light on the role obesity may play in causing heart attacks and, surprisingly, keeping them from being fatal.
The Impact of Obesity on Mortality in UA/non-ST-segment Elevation Myocardial Infarction (European Heart Journal)
In one study, published by the European Heart Journal, researchers followed more than 1,600 patients who were given angioplasty and, usually, stents after a type of heart attack known as unstable angina/non-ST-segment elevation. They found that the obese and very obese patients were only half as likely as those of normal weight to die in the three years after the attack.
Part of the explanation may be that obese people are more likely to have their heart problems detected by doctors and treated with medications that later help them recover from heart attacks.
Heart attack patients who are obese also tend to be younger. And other changes in the body that often occur with obesity may also help, the study said. (Of course, as the researchers noted, obesity is not desirable when it comes to heart disease; it causes medical problems that can lead to heart attacks in the first place.)
In the second study, presented at a recent meeting of the American Society of Echocardiography, researchers reported that excess weight was associated with a thickening of muscle in the left ventricle, the part of the heart that acts as a pump.
The study was led by researchers from the University of Arizona Sarver Heart Center.
Published: July 3, 2007
Two new studies shed light on the role obesity may play in causing heart attacks and, surprisingly, keeping them from being fatal.
The Impact of Obesity on Mortality in UA/non-ST-segment Elevation Myocardial Infarction (European Heart Journal)
In one study, published by the European Heart Journal, researchers followed more than 1,600 patients who were given angioplasty and, usually, stents after a type of heart attack known as unstable angina/non-ST-segment elevation. They found that the obese and very obese patients were only half as likely as those of normal weight to die in the three years after the attack.
Part of the explanation may be that obese people are more likely to have their heart problems detected by doctors and treated with medications that later help them recover from heart attacks.
Heart attack patients who are obese also tend to be younger. And other changes in the body that often occur with obesity may also help, the study said. (Of course, as the researchers noted, obesity is not desirable when it comes to heart disease; it causes medical problems that can lead to heart attacks in the first place.)
In the second study, presented at a recent meeting of the American Society of Echocardiography, researchers reported that excess weight was associated with a thickening of muscle in the left ventricle, the part of the heart that acts as a pump.
The study was led by researchers from the University of Arizona Sarver Heart Center.
Thursday, June 14, 2007
Unanimous "No" to Rimonabant: Safety Not Demonstrated, FDA Advisory Panel Says
Heartwire 2007. © 2007 Medscape
June 13, 2007 (Silver Spring, MD) - In a blow to the drug maker, as well as millions of overweight and obese Americans hoping for a new weight-loss medication, the FDA's Endocrinologic and Metabolic Drugs Advisory Committee voted unanimously to send Sanofi-Aventis back to gather more detailed safety information about rimonabant over the long term, in larger patient numbers.
After a day of discussion and presentations, all 14 members of the advisory committee agreed that rimonabant did not demonstrate a risk/benefit profile to enable it to be approved for the indication the sponsor was seeking: weight management in individuals with a body-mass index of >30 kg/m2 or in individuals with a BMI of >27 kg/m2 when accompanied by at least one comorbid condition.
The committee's concerns centered on what many concluded was a "clear" signal of increased risk of neurological side effects—seizures, depression, anxiety, aggressiveness, and suicidal thoughts among patients randomized to rimonabant. Many were also concerned about the low number of patients—441 in total—who had actually been taking the 20-mg dose for out to two years. Several panel members stated that even current, ongoing studies of rimonabant, including the CRESCENDO study, are not appropriately designed to clarify the types of adverse events occurring in people taking the drug.
A more detailed report on the rimonabant hearing will be posted by heartwire on Thursday.
June 13, 2007 (Silver Spring, MD) - In a blow to the drug maker, as well as millions of overweight and obese Americans hoping for a new weight-loss medication, the FDA's Endocrinologic and Metabolic Drugs Advisory Committee voted unanimously to send Sanofi-Aventis back to gather more detailed safety information about rimonabant over the long term, in larger patient numbers.
After a day of discussion and presentations, all 14 members of the advisory committee agreed that rimonabant did not demonstrate a risk/benefit profile to enable it to be approved for the indication the sponsor was seeking: weight management in individuals with a body-mass index of >30 kg/m2 or in individuals with a BMI of >27 kg/m2 when accompanied by at least one comorbid condition.
The committee's concerns centered on what many concluded was a "clear" signal of increased risk of neurological side effects—seizures, depression, anxiety, aggressiveness, and suicidal thoughts among patients randomized to rimonabant. Many were also concerned about the low number of patients—441 in total—who had actually been taking the 20-mg dose for out to two years. Several panel members stated that even current, ongoing studies of rimonabant, including the CRESCENDO study, are not appropriately designed to clarify the types of adverse events occurring in people taking the drug.
A more detailed report on the rimonabant hearing will be posted by heartwire on Thursday.
Friday, May 25, 2007
Bariatric Surgery for Morbid Obesity
The New England Journal of Medicine
Volume 356 — May 24, 2007 — Number 21
Bariatric Surgery for Morbid Obesity
Eric J. DeMaria, M.D.
This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations.
LINK: http://content.nejm.org/cgi/content/short/356/21/2176?rss=1&query=current
Volume 356 — May 24, 2007 — Number 21
Bariatric Surgery for Morbid Obesity
Eric J. DeMaria, M.D.
This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations.
LINK: http://content.nejm.org/cgi/content/short/356/21/2176?rss=1&query=current
Saturday, May 19, 2007
Rimonabant: A novel selective cannabinoid-1 receptor antagonist
Rimonabant: A novel selective cannabinoid-1 receptor antagonist for treatment of obesity
American Journal of Health-System Pharmacy, Vol. 64, Issue 5, 481-489
PRITI N. PATEL, PHARM.D., BCPS, is Assistant Clinical Professor, College of Pharmacy and Allied Health Professions, and Director, Drug Information Center, St. John’s University, Queens, NY. ROLEE PATHAK, PHARM.D., BCPS, is Clinical Assistant Professor, Ernest Mario College of Pharmacy, Rutgers University, Piscataway, NJ, and Clinical Coordinator, Englewood Hospital and Medical Center, Englewood, NJ.
Purpose. The pharmacology, pharmacokinetics, clinical efficacy, safety, drug interactions, and dosage and administration of rimonabant in the treatment of obesity and related metabolic factors are reviewed.
Summary. Discovery of the cannabinoid receptors has led to the development of rimonabant, a cannabinoid-1 (CB1) antagonist. Selective blockade of this receptor has been shown to lead to decreased appetite and food intake in animal models. Clinical studies have shown that rimonabant 20 mg once daily produces significant decreases in weight and waist circumference in obese human subjects and improves the lipid profile and glucose control. The frequency of metabolic syndrome also decreased significantly with rimonabant 20 mg daily. Limited data are available regarding the pharmacokinetics and pharmacodynamics of rimonabant. Preclinical data have demonstrated a long duration of action. As of yet, no drug–drug, drug–food, or drug– disease interactions have been identified with rimonabant. Adverse reactions occurred rarely, with nausea, dizziness, diarrhea, arthralgia, and back pain being the most common. Psychiatric disorders, including depression and anxiety, were the most common reasons for subjects to withdraw from rimonabant studies. Rimonabant has been shown to be safe for up to two years of treatment. Further research will clarify currently unknown areas, including pharmacokinetics, drug interactions, and the drug’s role in standard therapy.
Conclusion. Rimonabant, a selective CB1 antagonist, is a novel treatment option for obese and overweight individuals. Significant weight loss, decrease in waist circumference, and improvements in lipid profile and glucose control have been shown in clinical trials of rimonabant.
American Journal of Health-System Pharmacy, Vol. 64, Issue 5, 481-489
PRITI N. PATEL, PHARM.D., BCPS, is Assistant Clinical Professor, College of Pharmacy and Allied Health Professions, and Director, Drug Information Center, St. John’s University, Queens, NY. ROLEE PATHAK, PHARM.D., BCPS, is Clinical Assistant Professor, Ernest Mario College of Pharmacy, Rutgers University, Piscataway, NJ, and Clinical Coordinator, Englewood Hospital and Medical Center, Englewood, NJ.
Purpose. The pharmacology, pharmacokinetics, clinical efficacy, safety, drug interactions, and dosage and administration of rimonabant in the treatment of obesity and related metabolic factors are reviewed.
Summary. Discovery of the cannabinoid receptors has led to the development of rimonabant, a cannabinoid-1 (CB1) antagonist. Selective blockade of this receptor has been shown to lead to decreased appetite and food intake in animal models. Clinical studies have shown that rimonabant 20 mg once daily produces significant decreases in weight and waist circumference in obese human subjects and improves the lipid profile and glucose control. The frequency of metabolic syndrome also decreased significantly with rimonabant 20 mg daily. Limited data are available regarding the pharmacokinetics and pharmacodynamics of rimonabant. Preclinical data have demonstrated a long duration of action. As of yet, no drug–drug, drug–food, or drug– disease interactions have been identified with rimonabant. Adverse reactions occurred rarely, with nausea, dizziness, diarrhea, arthralgia, and back pain being the most common. Psychiatric disorders, including depression and anxiety, were the most common reasons for subjects to withdraw from rimonabant studies. Rimonabant has been shown to be safe for up to two years of treatment. Further research will clarify currently unknown areas, including pharmacokinetics, drug interactions, and the drug’s role in standard therapy.
Conclusion. Rimonabant, a selective CB1 antagonist, is a novel treatment option for obese and overweight individuals. Significant weight loss, decrease in waist circumference, and improvements in lipid profile and glucose control have been shown in clinical trials of rimonabant.
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