title: Impact of orlistat initiation on cardiovascular treatment use: a 6-year population-based cohort study.
abstract: BACKGROUND
  Trials of weight-loss drugs indicate some benefits on lipids, blood glucose, or blood pressure levels. Since obesity is associated with increased cardiovascular (CV) medication use and pharmaceutical costs, weight-loss drug use could beneficially impact CV medication use.
  
  
  OBJECTIVE
  We examined the temporal associations between CV drugs use 3 years before and after the initiation of orlistat, a weight-loss drug.
  
  
  METHODS
  An historical cohort study in the PHARMO pharmacy registry among new users of orlistat, who were in the database at least 3 years before and after such drug initiation. We assessed the prevalence of use of antihypertensive, antidiabetic, and lipid-lowering drugs within a 6-month period before and after orlistat initiation. Slopes and changes in slopes between these two periods were calculated using logistic generalized estimating equations and odds ratios (OR) with 95% confidence intervals (CI) are presented.
  
  
  RESULTS
  A total of 6139 subjects had a prescription of orlistat between January 1992 and May 2009. Mean ± SD age was 46.5 ± 12.5 years, with a majority of female (88.7%). Use of antihypertensive, antidiabetic, and lipid-lowering drugs increased over time, but after start of orlistat the slopes levelled-off. Initiation of orlistat resulted in a significant change in slope for antihypertensive (OR 0.79; 95% CI 0.77-0.81), antidiabetic (0.86; 0.83-0.90), and lipid-lowering drugs (0.84; 0.81-0.88).
  
  
  CONCLUSIONS
  Our data suggest a potential cost-effectiveness of orlistat, with a reduction in any cardiovascular comedication use over time. By potentially reducing costs of other medications use, orlistat remains as a unique option for tackling the obesity epidemic.
authors.affiliation: Unité de Recherche en Epidémiologie Nutritionnelle, Faculté de médecine SMBH, 74 rue Marcel Cachin, Bobigny, France. czernichow@uren.smbh.univ-paris13.fr
authors.forename: Sébastien
authors.initials: S
authors.lastname: Czernichow
authors.forename: Mirjam J
authors.initials: MJ
authors.lastname: Knol
authors.forename: Léopold
authors.initials: L
authors.lastname: Fezeu
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
mesh_terms: D000328:Adult; D019440:Anti-Obesity Agents / Q000191:economics / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D017046:Cost Savings; D016527:Drug Costs; D011307:Drug Prescriptions; D058872:Epidemics; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007783:Lactones / Q000191:economics / Q000627:therapeutic use*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology; D016017:Odds Ratio; D000077403:Orlistat; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000187:drug effects
chemical_list: D019440:Anti-Obesity Agents; D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007783:Lactones; D000077403:Orlistat