Cardiovascular Risks and Benefits of Medications Used for Weight Loss

Abstract

Obesity is a complex disease influenced by many neurohormonal pathways which regulate body weight toward homeostasis. Presently, the disease of obesity effects over a billion individuals worldwide with scalable treatment options in dire need. Pharmacologic interventions for obesity have been developed to help promote weight loss in individuals with obesity. This area is rapidly developing and will only exponentially increase to serve the demand for persons with obesity seeking biologically orientated solutions to treat their disease. Therefore, understanding the cardiovascular risks and benefits of these weight loss medications is of particularly importance due to obesities strong association with cardiovascular (CV) disease risk. Moreover, past experiences with pharmacotherapy agents with weight loss properties have demonstrated an association with adverse CV outcomes, leading to market removal, in most cases and concerns over using similar medications. To better understand the CV risks and benefits pharmacotherapy agents used for weight loss, this review will discuss medications which are FDA-approved for weight loss, as well as medications commonly used off-label for this indication. The goal is to provide an overview of the risks and benefits many of these medications can offer to help guide clinical decision making and patient education.

The Most Undertreated Chronic Disease: Addressing Obesity in Primary Care Settings

“…As with other diseases such as diabetes and hypertension, PCPs must understand the key biological underpinning of obesity and use any tools available for treatment, including pharmacotherapy. Additionally, some anti-obesity medications, such as glucagon-like peptide 1-receptor agonists (GLP-1RAs), have beneficial effects on cardiovascular outcomes and mortality [ 42 , 43 ].…”

Raspberry Ketone [4-(4-Hydroxyphenyl)-2-Butanone] Differentially Effects Meal Patterns and Cardiovascular Parameters in Mice

“…RK pretreatment reduced isoproterenol-induced cardiac tissue damage and dyslipidemia [ 19 , 20 ]. Because obesity therapeutic agents often are associated with adverse cardiovascular events [ 21 ], the RK doses that prevent weight gain should also be examined for their hemodynamic effects. Indeed, weight loss nutraceuticals are typically consumed on a long-term basis for several months, therefore, understanding the cardiovascular risks and benefits are critical for their assessment.…”

Evaluation of Pharmacologic Interventions for Weight Management in a Veteran Population

“…5,6 Studies looking at long-term effects of these medications on weight loss have found improvements in blood pressure (BP), biomarkers for cardiovascular disease, and T2DM-related comorbidities. 3,5,7 Positive effects on comorbidities have been found to be related to drug class and mechanism of action (MOA); those that also are approved for T2DM have demonstrated the most favorable cardiovascular effects. 7 Other medications that work as stimulants or as modulators of serotonin pathways are associated with increased risks, prompting the US Food and Drug Administration (FDA) to remove some medications from the market.…”

“…3,5,7 Positive effects on comorbidities have been found to be related to drug class and mechanism of action (MOA); those that also are approved for T2DM have demonstrated the most favorable cardiovascular effects. 7 Other medications that work as stimulants or as modulators of serotonin pathways are associated with increased risks, prompting the US Food and Drug Administration (FDA) to remove some medications from the market. 7,8 In January 2020, lorcaserin was taken off the market because of increased risk of cancer found in postmarketing surveillance.…”

“…7 Other medications that work as stimulants or as modulators of serotonin pathways are associated with increased risks, prompting the US Food and Drug Administration (FDA) to remove some medications from the market. 7,8 In January 2020, lorcaserin was taken off the market because of increased risk of cancer found in postmarketing surveillance. 9 The benefit of weight loss must be weighed against the risk of medication use.…”