Cardiometabolic Effects of Anti-obesity Pharmacotherapy

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

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.

Erchen decoction for hyperlipemia: Protocol for a systematic review and meta-analysis

BACKGROUND

Hyperlipidemia is a metabolic disease characterized by elevated levels of blood lipids and lipoproteins and a major pathogenic factor of atherosclerosis. In China, Erchen decoction (ECD) has been widely used to treat hyperlipidemia. However, there is no systematic review found. In order to evaluate the efficacy and safety of ECD in the treatment of hyperlipidemia, we need to conduct a meta-analysis and systematic evaluation.

METHODS

We will enroll the randomized controlled trials (RCTs) evaluating the effectiveness and safety of ECD in the treatment of hyperlipidemia. Data come mainly from 4 Chinese databases (China national knowledge infrastructure, Wanfang, Chinese biomedical literature database, and VIP Database) and 4 English databases (Pubmed, Embase excerpt medica database, Cochrane Library, and Web of science). The enrollment of RCTs is from the starting date of database establishment till September 30, 2020. Low density lipoprotein cholesterol is considered as the main indicator of the dyslipidemia, while the serum concentrations of total cholesterol, triglyceride, high density lipoprotein cholesterol, apolipoprotein A, and apolipoprotein B are regarded as the secondary indicators. There are Safety indicators including liver enzyme, kidney function and fasting blood glucose. The work such as selection of literature, data collection, quality evaluation of included literature, and assessment of publication bias will be conducted by 2 independent researchers. Meta-analysis will be performed by RevMan 5.0 software.

RESULTS

This study will provide high-quality evidence for the effectiveness and safety of ECD in the treatment of hyperlipidemia.

CONCLUSION

The results of the study will help us determine whether ECD can effectively treat hyperlipidemia.

ETHICS AND DISSEMINATION

This study does not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/GZ69F.

Myo-inositol and d-chiro-inositol oral supplementation ameliorate cardiac dysfunction and remodeling in a mouse model of diet-induced obesity

Obesity is an independent risk factor to develop cardiac functional and structural impairments. Here, we investigated the effects of supplementation of inositols on the electrical, structural, and functional cardiac alterations in the mouse model of high fat diet (HFD) induced obesity. Three groups of C57BL6 mice (n = 16 each) were studied: j) HFD feeding; jj) HFD feeding + inositols from week 9 to 13; jjj) standard diet feeding. Study observation period was 13 weeks. Inositols were administered as mixture of myo-inositol and d-chiro-inositol in the drinking water. Effects of inositols were evaluated based on electrical, structural, and functional cardiac features, autonomic sympatho-vagal balance and arrhythmogenic susceptibility to adrenergic challenge. Heart samples were collected for histological evaluations and transcriptional analyses of genes involved in defining the shape and propagation of the action potential, fatty acid metabolism and oxidative stress. Inositol supplementation significantly restored control values of heart rate and QTc interval on ECG and of sympatho-vagal balance. Moreover, it blunted the increase in left ventricular mass and cardiomyocyte hypertrophy, reversed diastolic dysfunction, reduced the susceptibility to arrhythmic events and restored the expression level of cardiac genes altered by HFD. The present study shows, for the first time, how a short period of supplementation with inositols is able to ameliorate the HFD-induced electrical, structural and functional heart alterations including ventricular remodeling. Results provide a new insight into the cardioprotective effect of inositols, which could pave the way for a novel therapeutic approach to the treatment of HFD obesity-induced heart dysfunction.

Human ApoA-I Overexpression Enhances Macrophage-Specific Reverse Cholesterol Transport but Fails to Prevent Inherited Diabesity in Mice

Human apolipoprotein A-I (hApoA-I) overexpression improves high-density lipoprotein (HDL) function and the metabolic complications of obesity. We used a mouse model of diabesity, the db/db mouse, to examine the effects of hApoA-I on the two main functional properties of HDL, i.e., macrophage-specific reverse cholesterol transport (m-RCT) in vivo and the antioxidant potential, as well as the phenotypic features of obesity. HApoA-I transgenic (hA-I) mice were bred with nonobese control (db/+) mice to generate hApoA-I-overexpressing db/+ offspring, which were subsequently bred to obtain hA-I-db/db mice. Overexpression of hApoA-I significantly increased weight gain and the incidence of fatty liver in db/db mice. Weight gain was mainly explained by the increased caloric intake of hA-I-db/db mice (>1.2-fold). Overexpression of hApoA-I also produced a mixed type of dyslipidemia in db/db mice. Despite these deleterious effects, the overexpression of hApoA-I partially restored m-RCT in db/db mice to levels similar to nonobese control mice. Moreover, HDL from hA-I-db/db mice also enhanced the protection against low-density lipoprotein (LDL) oxidation compared with HDL from db/db mice. In conclusion, overexpression of hApoA-I in db/db mice enhanced two main anti-atherogenic HDL properties while exacerbating weight gain and the fatty liver phenotype. These adverse metabolic side-effects were also observed in obese mice subjected to long-term HDL-based therapies in independent studies and might raise concerns regarding the use of hApoA-I-mediated therapy in obese humans.