Obesity has been identified as a risk factor for
atherosclerosis, and fat distribution has proved to be a critical variable.
Weight loss improves health, but failure rates in dietary treatment are high. The effects of
dexfenfluramine, which is useful in many patients, were studied on cardiovascular risk factors in obese female patients with upper and lower body
obesity.
METHODS: In a placebo-controlled, double-blind trial, which was part of a multicentre study, 52 obese female patients (body mass index 35.1 +/- 7.8 kg/m2, age 43.3 +/- 6.4 years) were given either 15 mg
dexfenfluramine twice daily, or placebo in addition to a
calorie-restricted diet (1500 kcal/day) for 12 months. Forty-two patients (20 with upper body
obesity, 12
dexfenfluramine and 10 placebo; 22 with lower body
obesity, 16
dexfenfluramine and six placebo) completed the 14-month study.
RESULTS: Patients with upper body
obesity lost 14.2 +/- 2.20 kg with
dexfenfluramine, and 4.92 +/- 2.99 kg with placebo (P < or = 0.05). In contrast, patients with lower body
obesity lost 11.1 +/- 2.89 kg with
dexfenfluramine and 2.6 +/- 2.32 kg with placebo (P < 0.05). With
dexfenfluramine, patients with upper body
obesity lost more weight than patients with lower body
obesity (P < 0.05). After 1 year of
dexfenfluramine treatment, reduction of systolic blood pressure in patients with upper body
obesity (157 +/- 10 versus 133 +/- 8 mmHg, P < 0.05) was significantly (P < 0.05) greater than in patients with lower body
obesity (136 +/- 14 versus 127 +/- 12 mmHg). During
dexfenfluramine treatment cardiovascular risk factors improved. In upper body
obesity blood glucose (5.18 +/- 0.28 versus 4.40 +/- 0.34 mmol/l, P < 0.05), serum
insulin (23.4 +/- 8.9 versus 13.2 +/- 4.2 microU/ml, P < 0.05) and
triglycerides (1.96 +/- 0.45 versus 1.23 +/- 0.54 mmol/l, P < 0.05) decreased, and
high-density lipoprotein cholesterol increased (1.0 +/- 0.14 versus 1.21 +/- 0.14 mmol/l P < 0.05). In lower-body
obesity, cardiovascular risk factors were in the normal range and did not change significantly during the study.
CONCLUSIONS: