Dexfenfluramine and heart-valve regurgitation in Chinese patients with type 2 diabetes.
OBJECTIVE
To assess whether valvular lesions are associated with the use of dexfenfluramine in Chinese patients with type 2 diabetes.


METHODS
Case-control study.


METHODS
Thirty-six obese Chinese patients with type 2 diabetes and a history of dexfenfluramine use during the period January 1992 and September 1997 were recruited into the study, while another 43 age- and sex-matched Chinese patients with type 2 diabetes were recruited as controls. The mean age for the cases was 44.1 years (standard deviation, 11.2 years; median, 42.5 years; range, 20-64 years). The 43 control subjects were age- and sex-matched, and had a mean age of 48.5 years (standard deviation, 10.9 years; median, 51.0 years; range, 16-63 years; P>0.05). The male-to-female ratio was confirmed as similar between the two groups (10:26 versus 12:31; P>0.05). All patients were clinically free from cardiovascular disease. Patients with a history of underlying valvular disease from any cause were excluded from the study. All patients underwent echocardiographic assessment, and the presence of any valvular lesions was documented.


RESULTS
The mean duration of dexfenfluramine use by the cases was 21.8 weeks (standard deviation, 29.0 weeks; median, 18.0 weeks; range, 1-160 weeks). Subjects with a history of dexfenfluramine use had higher rates of significant aortic regurgitation, tricuspid regurgitation of any severity, and of any valvular regurgitation, compared to controls (11.1% versus 0%, P<0.05; 30.6% versus 4.7%, P<0.01; and 61.1% versus 34.9%, P<0.05, respectively). Logistic stepwise regression analysis to predict the risk of valvular lesion was conducted, with age, sex, history of dexfenfluramine use, body mass index, waist-hip ratio, blood pressure, fasting plasma glucose, lipid profile, and duration of diabetes as independent variables. A history of dexfenfluramine use was the only significant parameter entered into the model (significant aortic regurgitation: beta=9.19, standard error=46.6, P<0.05; any tricuspid regurgitation: beta=2.76, standard error=10.8, P<0.05).


CONCLUSIONS
In Chinese patients with type 2 diabetes, a history of dexfenfluramine use is associated with heart-valve regurgitation, particularly aortic regurgitation.
Ko
G T C
GT
Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong. gtc_ko@hotmail.com
Chan
H C K
HC
Chow
C C
CC
D000328:Adult; D001022:Aortic Valve Insufficiency / Q000139:chemically induced* / Q000453:epidemiology; D001067:Appetite Depressants / Q000009:adverse effects*; D015992:Body Mass Index; D016022:Case-Control Studies; D002681:China / Q000208:ethnology; D020372:Dexfenfluramine / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004562:Electrocardiography; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D017366:Serotonin Receptor Agonists / Q000009:adverse effects; D014262:Tricuspid Valve Insufficiency / Q000139:chemically induced* / Q000453:epidemiology
D001067:Appetite Depressants; D017366:Serotonin Receptor Agonists; D020372:Dexfenfluramine