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Pharmacotherapy for Weight Reduction in Patients with Heart Disease

When to Consider Pharmacotherapy

Weight-loss medications may be considered when:

  1. BMI ≥ 30 kg/m²
  2. BMI ≥ 27 kg/m² with comorbidities such as coronary artery disease, hypertension, diabetes, or sleep apnea
  3. Failure to lose ≥5% body weight with lifestyle modification
  4. The patient is clinically stable and under cardiology supervision
Weight Loss Medications
  1. Orlistat
    • Mechanism: Inhibits dietary fat absorption
    • Cardiac Safety: Generally safe in heart disease
    • Effectiveness: 5 – 10% weight loss
    • Side Effects: GI upset, oily stools, fat-soluble vitamin deficiency
    • Contraindications: Malabsorption syndromes, history of kidney stones
  2. GLP-1 Receptor Agonists (e.g., Liraglutide, Semaglutide)
    • Mechanism: Appetite suppression, delayed gastric emptying, improves insulin sensitivity
    • Cardiac Safety: Cardioprotective in diabetics (e.g., LEADER trial)
    • Effectiveness: 10–15#37; weight loss
    • Side Effects: Nausea, vomiting, constipation, rare pancreatitis
    • Contraindications: Family or personal history of medullary thyroid cancer or MEN-2 syndrome, pancreatitis
  3. Naltrexone-Bupropion (Contrave), warningUse with Caution in Cardiac Patients
    • Mechanism: CNS appetite suppression
    • Effectiveness: 5–10% weight loss
    • Cardiac Concerns: May increase heart rate and blood pressure
    • Contraindications: Seizure disorders, uncontrolled hypertension, opioid use, recent MI or stroke
  4. Phentermine or Phentermine-Topiramate (Qsymia) - close Avoid in Heart Disease
    • Mechanism: Sympathomimetic appetite suppressant
    • Effectiveness: Up to 15% weight loss
    • Cardiac Risk: Increases BP and heart rate
    • Contraindications: Known CVD, arrhythmias, hyperthyroidism, glaucoma
  5. Those with high cholesterol or metabolic syndrome
  6. Sedentary individuals at risk of cardiac complications
General Contraindications in Heart Disease
  1. Recent myocardial infarction (<6 months)
  2. Unstable angina
  3. Uncontrolled arrhythmias
  4. NYHA class III–IV heart failure
  5. Severe valvular disease
  6. Uncontrolled hypertension
Monitoring and Safety
  1. Baseline and follow-up blood pressure, heart rate, and ECG if needed
  2. Track weight, waist circumference regularly
  3. Assess response: If < 5% weight loss after 12 weeks, stop the medication
  4. Monitor for side effects and adherence


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