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DIET PILLS LINKED TO VALVULAR HEART DISEASE.

In an unusual move, The New England Journal of Medicine has allowed the prepublication release of an article describing an association between valvular heart disease and combined therapy with fenfluramine and phentermine for weight reduction. The paper will appear in the August 28 issue of the Journal.

Physicians at the Mayo Clinic and the MeritCare Medical Center in Fargo, North Dakota, report the cases of 24 women with no prior history of heart disease who took fenfluramine plus phentermine. After an average of one year on the medication, patients presented with cardiovascular symptoms and new heart murmurs reflecting mitral, aortic, and/or tricuspid regurgitation; eight had newly documented pulmonary hypertension. So far, five patients have required valvular surgery. The affected valves had a glistening white appearance with pathologic features similar to those seen in carcinoid or ergotamine-induced valvular disease.

Comment: Although this series is highly suggestive, it does not prove conclusively that these medications cause valvular cardiac disease. Only last year, the related drug dexfenfluramine was implicated as a possible cause of pulmonary hypertension (see JW feature, Dec 1 1996, p. 190). The authors speculate that fenfluramine plus phentermine might alter serotonin metabolism and thus cause carcinoid-like lesions. While the frequency of this association remains unclear, this report has prompted the FDA to issue a warning to patients and health professionals.

— AS Brett

Published in Journal Watch General Medicine July 18, 1997

Citation(s):

Connolly HM et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med 1997 Aug 28 337 581-588.