BETHESDA-Here’s a recipe for dieters whose pills were pulled.
Three federal agencies say that all patients who took recalled fenfluramine or dexfenfluramine should have an echocardiogram if they have heart or lung symptoms. Even if asymptomatic, they should be “strongly considered” for an echo before dental or surgical procedures that carry an endocarditis risk, says the FDA, CDC, and NIH.
But the American Heart Association and the American College of Cardiology, while basically supporting the feds, hedged on full backing, with an eye on overuse of echos and antibiotics.
The AHA says physicians “may consider” echos for overweight patients with no signs or symptoms of valvular disease. “That’s giving physicians a little bit more room,” says Dr. Ann Bolger of Belvedere, Calif., a member of AHA’s committee on endocarditis. Inappropriate antibiotic prophylaxis should be avoided, the AHA says, by making sure valvulopathy is clinically significant. Small studies have suggested that up to a third of drug-takers may have valvular pathology.
The ACC also calls for clinical judgment rather than cookbook medicine on echos for symptom-free patients. Additionally, the ACC recommends a repeat physical after six to eight months for patients without symptoms who’ve used anorectic drugs.
The ACC worries that if every one of the 1.2 million to 4.7 million Americans who the CDC says took at least one of the diet drugs were to have an echo, it could overload the system.
A new study of 226 patients found that 25% had valvular disease, vs. 1% of 81 controls, Dr. Mehmood Khan of the Hennepin County (Minn.) Medical Center told the North American Association for the Study of Obesity meeting in Cancun. -Anne S. Harding
BETHESDA-Here’s a recipe for dieters whose pills were pulled.
