| アブストラクト | AIMS: The rising prevalence of obesity and its associated comorbidities represent a growing public health issue; in particular, obesity is known to be a major risk factor for cardiovascular disease. Despite the evidence behind the efficacy of orlistat in achieving weight loss in patients with obesity, no study thus far has quantified its long-term effect on cardiovascular outcomes. The purpose of this study is to explore long-term cardiovascular outcomes after orlistat therapy. METHODS AND RESULTS: A propensity-score matched cohort study was conducted on the nation-wide electronic primary and integrated secondary healthcare records of the Clinical Practice Research Datalink (CPRD). The 36 876 patients with obesity in the CPRD database who had completed a course of orlistat during follow-up were matched on a 1:1 basis with equal numbers of controls who had not taken orlistat. Patients were followed up for a median of 6 years for the occurrence of the primary composite endpoint of major adverse cardiovascular events (fatal or non-fatal myocardial infarction or ischaemic stroke), and a number of secondary endpoints including primary endpoint components individually, the occurrence of new-onset heart failure, coronary revascularization, new chronic kidney disease stage III+ (CKD3+), and all-cause mortality. During the median study follow-up of 6 years, the occurrence of major adverse cardiovascular events was lower in the orlistat cohort [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.66-0.83, P < 0.001]. Patients who took orlistat experienced lower rates of myocardial infarction (HR 0.77; 95% CI 0.66-0.88, P < 0.001) and ischaemic stroke (HR 0.68; 95% CI 0.56 to -0.84, P < 0.001) as well as new-onset heart failure (HR 0.79; 95% CI 0.67-0.94, P = 0.007). There was no differences in revascularization rates (HR 1.12; 95% CI 0.91-1.38, P = 0.27), but a lower rate of both CKD3+ development (HR 0.78; 95% CI 0.73-0.83, P < 0.001) and mortality (HR 0.39, 95% CI 0.36 to -0.41, P < 0.001) was observed. CONCLUSION: In this nation-wide, propensity-score matched study, orlistat was associated with lower rates of overall major adverse cardiovascular events, new-onset heart failure, renal failure, and mortality. This study adds to current evidence on the known improvements in cardiovascular risk factor profiles of orlistat treatment by suggesting a potential role in primary prevention. |
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| ジャーナル名 | European heart journal. Cardiovascular pharmacotherapy |
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| 投稿日 | 2021/5/16 |
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| 投稿者 | Ardissino, Maddalena; Vincent, Matthew; Hines, Oliver; Amin, Ravi; Eichhorn, Christian; Tang, Alice R; Collins, Peter; Moussa, Osama; Purkayastha, Sanjay |
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| 組織名 | Department of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ,;UK.;Department of Medical Statistics, London School of Hygiene and Tropical Medicine,;London WC1E 7HT, UK.;Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK.;Royal Brompton Hospital and National Heart and Lung Institute, Imperial College;London, Sydney Street, London SW3 6NP, UK.;Division of Surgery and Cancer, Imperial College London, Praed Street, London W2;1NY, UK.;Imperial Weight Centre, Imperial College Healthcare NHS trust, Praed Street,;London W2 1NY, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/33991094/ |
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