According to a leading Canadian researcher, Xenical, a recently-approved prescription medication for weight loss, in combination with a mild calorie-reduced diet can significantly reduce the risk of cardiovascular disease in obese patients. In clinical trials, patients on Xenical showed significant reductions in cholesterol, insulin and glucose levels, as well as in blood pressure, which are all important causes of cardiovascular disease.

Dr. Jean-Pierre Després, scientific director of the Lipid Research Centre at Laval University in Quebec City and director of research at the Quebec Heart Institute, was one of the researchers who presented these facts during a symposium at the European Society of Cardiology meeting in Barcelona this past weekend.

Physicians traditionally have focussed on coronary prevention by managing individual risk factors such as diabetes, hypertension or abnormal lipid levels. But since particularly obese individuals tend to have more than one risk factor, this is not always effective. For example, a patient who is given beta-blockers to decrease blood pressure may experience weight gain, which worsens the lipid levels in their blood.

"Xenical is a very effective drug to produce significant weight loss and obesity is at the root of many of the cardiovascular risk factors that physicians encounter with their patients," Dr. Després said. "Being able to treat the obesity itself is much more effective than treating individual risk factors as they become apparent."

He said that weight reduction should be a primary goal in the prevention of heart disease in people who are overweight or obese, a belief shared by the other physicians participating in the symposium.

"Long-term weight management has a fundamental role in multiple risk factor reduction in overweight or obese patients," said Dr. James Shepherd, professor and head of the department of pathological biochemistry at the University of Glasgow. "Obesity is associated with a number of other risk factors for coronary heart disease [CHD], like hypertension and dyslipidemia, as well as being an independent predictor of cardiovascular disease."

Numerous studies have shown that a modest weight reduction of five to 10 per cent of initial body weight is associated with marked improvements in cardiovascular risk factors. In a recent study published in the journal The Lancet, Xenical was on average more than twice as effective at achieving and maintaining this weight loss than diet alone, with highly dedicated and compliant patients losing even more.

Dr. Shepherd noted that recent guidelines for the management of obesity and cardiovascular risk reduction recommend that patients with a BMI of 27 to 28 with accompanying cardiovascular risk factors be considered for weight loss pharmacotherapy.

Health Canada approved Xenical for the treatment of obesity in June. Xenical is non-systemically acting. It acts in the digestive tract to block the absorption of 30 per cent of dietary fat. It is not absorbed into the bloodstream, thereby protecting other organ systems. Other anti-obesity medications act in the brain and have been shown to cause cardiovascular-related side effects, contrary to the primary objective.

"The effects of Xenical on the CHD risk profile that have been observed in clinical trials suggest a new option in the management of coronary risk in overweight patients," Dr. Shepherd said.

Xenical has also been shown to have an important impact on type II diabetes. More than 80 per cent of patients with this disease are obese and the link between type II diabetes and cardiovascular disease is well recognised. A person with type II diabetes is two to four times more likely to die from coronary heart disease.

Dr. Luc Van Gaal, associate professor of endocrinology, metabolism and clinical nutrition at University Hospital Antwerp in Belgium, suggested that effective, long-term weight control is a key strategy in reducing CHD risks in overweight patients with type II diabetes. Studies have shown that weight reduction may reduce or eliminate the need for medication in some diabetic patients.

In one trial, patients with type II diabetes who lost more than five per cent of their initial body weight had significant improvements in fasting glucose and insulin levels, a reduction in serum triglycerides and an increase in HDL or good cholesterol levels.

Dr. Van Gaal said the ability to reduce the amount of medication patients must take is important because many diabetes medications, such as sulphonylureas or insulin, promote weight gain. This can make it very difficult for many patients to maintain their weight loss.

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