People with obesity using orlistat for weight loss may benefit from lower rates of overall major cardiovascular events, new-onset heart failure, renal failure, and mortality, according to study results published in the European Heart Journal – Cardiovascular Pharmacotherapy.
Because diet and lifestyle measures can have variable and limited effects on the initial management of obesity and bariatric surgery remains an invasive and expensive option, pharmacologic weight loss agents provide another weight-loss alternative for individuals with obesity.
Orlistat, a lipase inhibitor, is 1 of 4 agents approved by the US Food and Drug Administration and the only drug licensed for use in the UK. However, although previous studies have successfully measured the effect of orlistat for weight loss, its long-term effects on cardiovascular events are unknown.
A team of UK-based investigators conducted a nationwide propensity-matched cohort study to determine the long-term cardiovascular outcomes in patients with obesity who were administered orlistat therapy. The composite primary endpoints were major adverse cardiovascular events, including fatal and nonfatal myocardial infarction or ischemic stroke; new-onset heart failure; coronary revascularization; new chronic kidney disease (stage III or greater); and all-cause mortality.
A total of 36,876 patients with obesity with health records in the Clinical Practice Research Datalink who had completed a course of orlistat during follow-up were matched (1:1) with patients who had not taken orlistat. The median follow-up was 6 years, at which time patients in the orlistat cohort had less occurrence of major adverse cardiovascular events compared with patients who were not treated with orlistat (hazard ratio [HR], 0.74; P <.001).
Compared with untreated patients, patients treated with orlistat also had lower rates of myocardial infarction (HR, 0.77; P <.001), ischemic stroke (HR, 0.68; P <.001), new-onset heart failure (HR, 0.79; P =.007), development of stage III or greater chronic kidney disease (HR, 0.78; P <.001), and mortality (HR, 0.39; P <.001). No differences were observed in revascularization rates between the 2 cohorts.
“The primary finding of our study is an association between orlistat therapy and lower long-term rates of major adverse cardiovascular events; indicating that, in line with the fact that orlistat helps control weight and improve cardiovascular risk factors, it may also be associated with a sustained improvement in cardiovascular event rates,” the authors noted.
Ardissino M, Vincent M, Hines O, et al; on behalf of the Imperial Obesity Study Group. Long-term cardiovascular outcomes after orlistat therapy in patients with obesity: a nationwide, propensity-score matched cohort study. Eur Heart J Cardiovasc Pharmacother. Published online May 15, 2021. doi:10.1093/ehjcvp/pvaa133