RESUMO
Cardiovascular alterations are part of the obesity-related metabolic syndrome. The objective of this study was to verify the effect of sibutramine on obese patients heart rate. Systematic review of randomized clinical trials performed in the Brazilian Cochrane center, in obese patients, on use of sibutramine or placebo. Outcome: change in heart rate. Electronic database searched: Cochrane library, Medline, LILACS, Pubmed. There were no language, date, or other restrictions. Two reviewers made data collection and extraction, who independently obtained full articles of all eligible papers. Four studies provided dichotomous data for a meta-analysis, the outcome of which was favorable to placebo: relative risk (RR) 3.73, confidence interval (CI) 2.07 to 6.73, risk difference (RD) of 0.13, number needed to harm (NNH) of 7. Ten studies presented continuous data for a meta-analysis, the result of which was favorable to placebo: mean difference (MD) of 7.24, CI of 6.22-8.26. The use of sibutramine in obese patients significantly affects the heart rate.
Alterações cardiovasculares são parte da síndrome metabólica relacionada à obesidade. O objetivo deste estudo foi verificar a influência da sibutramina sobre a frequência cardíaca em pacientes obesos.Revisão sistemática de ensaios clínicos randomizados realizados no centro Cochrane do Brasil em pacientes obesos em uso de sibutramina ou placebo. Desfecho: alteração da frequência cardíaca. Banco de dados eletrônico pesquisados: Cochrane Library, Medline, LILACS, Pubmed. Não houve restrições quanto a idioma, data, ou outras restrições. Coleta de dados e extração foi realizada por dois revisores, que de forma independente obteve artigos na íntegra de todos os estudos elegíveis. Quatro estudos forneceram dados dicotômicos para uma meta-análise, cujo resultado foi favorável ao placebo:risco relativo (RR) 3,73, intervalo de confiança (IC) 2,07-6,73, diferença de risco (DR) de 0.13, número necessário para causar lesão (NNL) de 7. Dez estudos apresentaram dados contínuos para uma metanálise, cujo resultado foi favorável ao placebo: diferença média (DM) de 7,24, IC de 6,22-8,26. O uso da sibutramina em pacientes obesos afeta significativamente a frequência cardíaca.
Assuntos
Humanos , Depressores do Apetite/uso terapêutico , Frequência Cardíaca , Obesidade/tratamento farmacológico , Redução de PesoRESUMO
Billions of dollars are spent annually in the United States in the largely unregulated market of dietary supplements. Many of these supplements are marketed as weight-loss and athletic-performance-enhancement products. The association of various ephedra-containing products with adverse cardiovascular events has led to a ban on the sale of these products by the U.S. Food and Drug Administration. The result has been the emergence of new formulations marketed for weight loss and athletic-performance enhancement that are "ephedra-free" but contain other sympathomimetic substances, the safety of which has not been established. We present the case of a previously healthy 24-year-old man who presented with an ST-segment-elevation myocardial infarction (STEMI) within hours of taking the ephedra-free product Nutrex Lipo-6x. Emergent coronary angiography revealed the presence of extensive, diffuse thrombus in the left anterior descending coronary artery. The patient had no risk factors for coronary artery disease or myocardial infarction; this includes the absence of a hypercoagulable state and the absence of a history of illicit drug use. This case of STEMI--associated as it is with the use of a synephrine-containing product by a person without risk factors for coronary artery disease--is to our knowledge the 1st reported in the literature. We discuss the patient's evaluation and clinical course, and we review the literature with respect to synephrine-containing dietary supplements. On the basis of synephrine's chemical composition and mechanism of action, we propose a direct association between this patient's use of Nutrex Lipo-6x and his STEMI.
