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Long-term cardiovascular outcomes after orlistat therapy in patients with obesity: a nationwide, propensity score matched cohort study

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Title: Long-term cardiovascular outcomes after orlistat therapy in patients with obesity: a nationwide, propensity score matched cohort study
Authors: Moussa, O
Ardissino, M
Vincent, M
Hines, O
Amin, R
Eichhorn, C
Tang, AR
Collins, P
Purkayastha, S
Item Type: Journal Article
Abstract: 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.
Issue Date: Mar-2022
Date of Acceptance: 3-Nov-2020
URI: http://hdl.handle.net/10044/1/85011
DOI: 10.1093/ehjcvp/pvaa133
ISSN: 2055-6845
Publisher: Oxford University Press (OUP)
Start Page: 179
End Page: 186
Journal / Book Title: European Heart Journal - Cardiovascular Pharmacotherapy
Volume: 8
Issue: 2
Copyright Statement: Copyright reserved
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com. This is a pre-copy-editing, author-produced version of an article accepted for publication in European Heart Journal - Cardiovascular Pharmacotherapy following peer review. The definitive publisher-authenticated version is available online at: https://academic.oup.com/ehjcvp/advance-article/doi/10.1093/ehjcvp/pvaa133/6274862
Sponsor/Funder: Imperial College Healthcare NHS Trust
Funder's Grant Number: 72100-74250
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Weight loss
1102 Cardiorespiratory Medicine and Haematology
1117 Public Health and Health Services
Cardiovascular System & Hematology
Publication Status: Published
Online Publication Date: 2021-05-15
Appears in Collections:Department of Surgery and Cancer
National Heart and Lung Institute
Faculty of Medicine