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Cardiovascular safety of long-term anti-obesity drugs in subjects with overweight or obesity: a systematic review and meta-analysis

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Abstract

Purpose

Anti-obesity therapy can reduce body weight; however, it is not clear whether it can reduce major adverse cardiovascular events (MACEs). We conducted a systematic review and meta-analysis to assess the effect of long-term anti-obesity drugs on MACEs in individuals with overweight or obesity.

Methods

The MEDLINE, Embase, and Cochrane Library databases and clinical trial registries (https://clinicaltrials.gov) were searched up to 3 May 2021 for randomized controlled trials (RCT) that compared anti-obesity drugs with controls and reported cardiovascular events in subjects with overweight or obesity. Heterogeneity was described by the I2 value. The Mantel–Haenszel randomized effects model was adopted to calculate risk ratios (RR) and weighted mean differences (WMD). Sensitivity analysis was used to assess the stability of the effects. Publication bias was assessed by Begg's funnel plot and Egger's test. The Cochrane Collaboration risk-of-bias tool was used to evaluate the bias of each included RCT.

Results

Twelve articles were included; 21,391 and 17,618 subjects were in the anti-obesity drug and placebo groups, respectively. There was no difference in MACEs between the anti-obesity drug and placebo groups (RR 0.99; 95% CI: 0.88–1.12). Compared with placebo, anti-obesity interventions reduced body weight (WMD: − 3.96 kg; 95% CI: − 4.89, − 3.03) and improved lipid and blood glucose profiles. The intervention also did not increase the incidence of depression or anxiety or the risk of suicidal ideation.

Conclusion

Long-term anti-obesity drugs did not show a benefit in lowering MACEs in overweight or obese subjects, although the drugs resulted in a decrease in body weight and improved cardiometabolic parameters.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by grants from the National Natural Science Foundation of China [81673803].

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Authors and Affiliations

  1. Department of General Practice, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Lin Zhang

  2. Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Zhi Liu, Shenling Liao, He He & Mei Zhang

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L.Z. searched the library and wrote the manuscript text. Z.L and S.L.L extracted data and reviewed all articles. H.H and M.Z evaluated the bias. M.Z designed the manuscript. All authors reviewed the manuscript.

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Correspondence to Mei Zhang.

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Zhang, L., Liu, Z., Liao, S. et al. Cardiovascular safety of long-term anti-obesity drugs in subjects with overweight or obesity: a systematic review and meta-analysis. Eur J Clin Pharmacol 77, 1611–1621 (2021). https://doi.org/10.1007/s00228-021-03160-7

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