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Cataldi M, Cignarelli A, Giallauria F, et al. Cardiovascular effects of antiobesity drugs: are the new medicines all the same?. Int J Obes Suppl. 2020;10(1):14-26doi: 10.1038/s41367-020-0015-3.
Cataldi, M., Cignarelli, A., Giallauria, F., Muscogiuri, G., Barrea, L., Savastano, S., Colao, A. (2020). Cardiovascular effects of antiobesity drugs: are the new medicines all the same?. International journal of obesity supplements, 10(1), 14-26. https://doi.org/10.1038/s41367-020-0015-3
Cataldi, Mauro, et al. "Cardiovascular effects of antiobesity drugs: are the new medicines all the same?." International journal of obesity supplements vol. 10,1 (2020): 14-26. doi: https://doi.org/10.1038/s41367-020-0015-3
Cataldi M, Cignarelli A, Giallauria F, Muscogiuri G, Barrea L, Savastano S, Colao A. Cardiovascular effects of antiobesity drugs: are the new medicines all the same?. Int J Obes Suppl. 2020 Jul;10(1):14-26. doi: 10.1038/s41367-020-0015-3. Epub 2020 Jul 20. PMID: 32714509; PMCID: PMC7371629.
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Int J Obes Suppl. 2020 Jul;10(1):14-26. doi: 10.1038/s41367-020-0015-3. Epub 2020 Jul 20.

Cardiovascular effects of antiobesity drugs: are the new medicines all the same?.

International journal of obesity supplements

Mauro Cataldi, Angelo Cignarelli, Francesco Giallauria, Giovanna Muscogiuri, Luigi Barrea, Silvia Savastano, Annamaria Colao,

Affiliations

  1. Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology, Federico II University of Naples, Naples, Italy.
  2. Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy.
  3. Department of Translational Medical Sciences, Internal Medicine (Metabolic and Cardiac Rehabilitation Unit), Federico II University of Naples, Naples, Italy.
  4. Department of Clinical Medicine and Surgery, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.

PMID: 32714509 PMCID: PMC7371629 DOI: 10.1038/s41367-020-0015-3

Abstract

Waiting for a definite answer from well-designed randomized prospective clinical trials, the impact of the new antiobesity drugs -liraglutide, bupropion/naltrexone, phentermine/topiramate and lorcaserin- on cardiovascular outcomes remains uncertain. What has been learned from previous experience with older medicines is that antiobesity drugs may influence cardiovascular health not only causing weight reduction but also through direct actions on the cardiovascular system. Therefore, in the present review, we examine what is known, mainly from preclinical investigations, about the cardiovascular pharmacology of the new antiobesity medicines with the aim of highlighting potential mechanistic differences. We will show that the two active substances of the bupropion/naltrexone combination both exert beneficial and unwanted cardiovascular effects. Indeed, bupropion exerts anti-inflammatory effects but at the same time it does increase heart rate and blood pressure by potentiating catecholaminergic neurotransmission, whereas naltrexone reduces TLR4-dependent inflammation and has potential protective effects in stroke but also impairs cardiac adaption to ischemia and the beneficial opioid protective effects mediated in the endothelium. On the contrary, with the only exception of a small increase in heat rate, liraglutide only exerts favorable cardiovascular effects by protecting myocardium and brain from ischemic damage, improving heart contractility, lowering blood pressure and reducing atherogenesis. As far as the phentermine/topiramate combination is concerned, no direct cardiovascular beneficial effect is expected for phentermine (as this drug is an amphetamine derivative), whereas topiramate may exert cardioprotective and neuroprotective effects in ischemia and anti-inflammatory and antiatherogenic actions. Finally, lorcaserin, a selective 5HT

© The Author(s), under exclusive licence to Springer Nature Limited 2020.

Conflict of interest statement

Conflict of interestAC received lecture fees from Eli Lilly, Novo Nordisk, Sanofi Aventis, Astra Zeneca, Bruno farmaceutici, Roche. The remaining authors have nothing to disclose.

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