Silver Lining to the Cloud over Anorexogen-Related Cardiac Valvulopathy?
Authors: Martin St John Sutton
Journal: Annals of Internal Medicine (2001)

Editorials20 February 2001Silver Lining to the Cloud over Anorexogen-Related Cardiac Valvulopathy?Martin St John Sutton, MD, FRCPMartin St John Sutton, MD, FRCPDr. Sutton: Hospital of the University of Pennsylvania; Philadelphia, PA 19104Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-134-4-200102200-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Pharmacologic appetite suppression has been used as an alternative strategy in the treatment of obesity for four decades. Anorexogen therapy is a more “attractive” method of losing weight than prolonged, often unsuccessful dietary restriction or gastric bypass or stapling procedures that facilitate gastric emptying. The appetite-suppressing effect of anorexogens is mediated by altering serotonin kinetics; phentermine inhibits clearance of serotonin in the lungs, and fenfluramine stimulates its release and blocks its neuronal reuptake. The common aim of the different therapies, used singly or in combination, is to reduce the morbidity due to coronary heart disease, stroke, and hypertension associated with ...References1. Abenhaim L, Moride Y, Brenot F, Rich S, Benichou J, Kurz X, et al . Appetite-suppressant drugs and the risk of primary pulmonary hypertension. International Primary Pulmonary Hypertension Study Group. N Engl J Med. 1996;335:609-16. [PMID: 0008692238] CrossrefMedlineGoogle Scholar2. Weintraub M. Long-term weight control: the National Heart, Lung, and Blood Institute funded multimodal intervention study. Clin Pharmacol Ther. 1992;51:581-5. [PMID: 0001445528] CrossrefMedlineGoogle Scholar3. . 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Low prevalence of valvular heart disease in 226 phentermine-fenfluramine protocol subjects prospectively followed for up to 30 months. J Am Coll Cardiol. 1999;34:1153-8. [PMID: 0010520805] CrossrefMedlineGoogle Scholar11. Jollis JG, Landolfo CK, Kisslo J, Constantine GD, Davis KD, Ryan T. Fenfluramine and phentermine and cardiovascular findings: effect of treatment duration on prevalence of valve abnormalities. Circulation. 2000;101:2071-7. [PMID: 0010790349] CrossrefMedlineGoogle Scholar12. Gardin JM, Schumacher D, Constantine G, Davis KD, Leung C, Reid CL. Valvular abnormalities and cardiovascular status following exposure to dexfenfluramine or phentermine/fenfluramine. JAMA. 2000;283:1703-9. [PMID: 0010755496] CrossrefMedlineGoogle Scholar13. Weissman NJ, Tighe JF, Gottdiener JS, Gwynne JT. Prevalence of valvular-regurgitation associated with dexfenfluramine three to five months after discontinuation of treatment. J Am Coll Cardiol. 1999;34:2088-95. [PMID: 0010588229] CrossrefMedlineGoogle Scholar14. Cannistra LB, Cannistra AJ. Regression of multivalvular regurgitation after the cessation of fenfluramine and phentermine treatment. [Letter]. N Engl J Med. 1998;339:771. [PMID: 0009742026] CrossrefMedlineGoogle Scholar15. Hensrud DD, Connolly HM, Grogan M, Miller FA, Bailey KR, Jensen MD. Echocardiographic improvement over time after cessation of use of fenfluramine and phentermine. Mayo Clin Proc. 1999;74:1191-7. [PMID: 0010593346] CrossrefMedlineGoogle Scholar16. Weissman NJ, Panza JA, Tighe JF, Gwynne JT. Natural history of valvular regurgitation 1 year after discontinuation of dexfenfluramine therapy. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2001;134:267-73. LinkGoogle Scholar17. Mast ST, Jollis JG, Ryan T, Anstrom KJ, Crary JL. The progression of fenfluramine-associated valvular heart disease assessed by echocardiography. Ann Intern Med. 2001;134:261-6. LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Martin St John Sutton, MD, FRCPAffiliations: Dr. Sutton: Hospital of the University of Pennsylvania; Philadelphia, PA 19104Corresponding Author:Martin St John Sutton, MD, FRCP, Cardiology Division, Hospital of the University of Pennsylvania, East Gates Building, Room 9017, Philadelphia, PA 19104. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Progression of Fenfluramine-Associated Valvular Heart Disease Assessed by Echocardiography Steven T. Mast , James G. Jollis , Thomas Ryan , Kevin J. Anstrom , and Jack L. Crary Natural History of Valvular Regurgitation 1 Year after Discontinuation of Dexfenfluramine Therapy Neil J. Weissman , Julio A. Panza , John F. Tighe Jr. , and John T. Gwynne Fenfluramine and Phentermine Diane Howlin Anorexogen-Related Cardiac Valvulopathy Richard B. Rothman Metrics Cited byWhy are anti-obesity drugs stigmatized?Anorexogen-Related Cardiac ValvulopathyRichard B. Rothman, MD, PhDFenfluramine and PhentermineDiane Howlin, MD 20 February 2001Volume 134, Issue 4 Page: 335-337 Keywords Drug therapy Echocardiography Food and Drug Administration Mitral insufficiency Obesity Overweight Pulmonary hypertension Serotonin Valvular diseases Weight loss ePublished: 20 February 2001 Issue Published: 20 February 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...