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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 Cardiovascular Obesity Orlistat Weight loss outcomes 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 |