The association between valvular heart disease and diet pills was discovered several years ago in a small cohort of patients. Subsequent uncontrolled surveys and reports suggested a prevalence of cardiac abnormalities as high as 30%. These results led to widespread concern by millions of appetite suppressant users and the withdrawal of both fenfluramine and dexfenfluramine from the market. Through this review of the literature, it becomes apparent that we have better defined the association between valvular heart disease and appetite suppressants; nonetheless, many questions and controversies remain. Most large scale, multicenter, controlled studies have shown that a prevalence of significant valve regurgitation is between 2 and 12% and that the likelihood of disease increases with increasing dose and/or duration of appetite suppressant use, but several other issues, such as the mechanism of action, remain unanswered.
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Dr. Weissman was the principal investigator and primary author of a large, multicenter study on dexfenfluramine, which was sponsored by Wyeth-Ayerst Labs. He has no personal financial conflict of interest with any appetite suppressant manufacturer.
© 2001 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.