Abnormal function of the endothelial cells, which line the walls of all blood vessels, and elevated levels of C-reactive protein (CRP) are associated with an increased risk of heart attacks.
Obese people tend to have abnormal endothelial cell function and high CRP levels, but both of these markers can be improved with weight loss.
Like most physicians, I haven't done well in efforts to get my patients to lose significant weight by changing their diet and exercise habits. Still, I have been reluctant to prescribe weight loss drugs because of poor experiences with such drugs in the past. The results of one recent study may lead me to change my thinking.
In this study 80 obese people with stable coronary artery disease were randomly assigned to receive either routine treatment (control group) or the weight loss drug sibutramine (Meridia). After four months, the sibutramine group had lost 11 percent of their initial body weight, compared with a loss of just 2 percent in the control group.
The sibutramine group also had significantly improved endothelial cell function and CRP compared to the control group. Sibutramine therapy caused no complications and was so well tolerated that no patients withdrew from the study.
Because increases in heart rate and blood pressure are significant side effects of sibutramine, it generally has not been given to patients with a history of coronary heart disease, heart failure, irregular heart rate, stroke, or uncontrolled blood pressure.
Nonetheless, the results of this study suggest that sibutramine might be an option for obese people with stable heart disease who fail to lose enough weight with lifestyle measures.