title: Changes in body weight and pulse: outcome events in overweight and obese subjects with cardiovascular disease in the SCOUT trial.
abstract: OBJECTIVE
  The Sibutramine Cardiovascular OUTcomes (SCOUT) trial showed a significantly increased relative risk of nonfatal cardiovascular events, but not mortality, in overweight and obese subjects receiving long-term sibutramine treatment with diet and exercise. We examined the relationship between early changes (both increases and decreases) in pulse rate, and the impact of these changes on subsequent cardiovascular outcome events in both the placebo and sibutramine groups.
  
  
  METHODS
  9804 males and females, aged ⩾55 years, with a body mass index of 27-45 kg m(-)(2) were included in this current subanalysis of the SCOUT trial. Subjects were required to have a history of cardiovascular disease and/or type 2 diabetes mellitus with at least one cardiovascular risk factor, to assess cardiovascular outcomes. The primary outcome event (POE) was a composite of nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death. Time-to-event analyses of the POE were performed using Cox regression models.
  
  
  RESULTS
  During the initial 6-week sibutramine treatment period, the induced pulse rate increase was related to weight change (1.9±7.7 beats per minute (bpm)  with weight increase; 1.4±7.3 bpm, 0-5 kg weight loss; 0.6±7.4 bpm, ⩾5 kg weight loss). Throughout the subsequent treatment period, those continuing on sibutramine showed a consistently higher mean pulse rate than the placebo group. There was no difference in POE rates with either an increase or decrease in pulse rate over the lead-in period, or during lead-in baseline to 12 months post randomization. There was also no relationship between pulse rate at lead-in baseline and subsequent cardiovascular events in subjects with or without a cardiac arrhythmia.
  
  
  CONCLUSIONS
  Baseline pulse rate and changes in pulse rate may not be an important modifier nor a clinically useful predictor of outcome in an individual elderly cardiovascular obese subject exposed to weight management.
authors.affiliation: The Boden Institute of Obesity, Nutrition Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: R V
authors.initials: RV
authors.lastname: Seimon
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Espinoza
authors.affiliation: National Centre for Cardiovascular Prevention and Outcomes, University College London, Institute for Cardiovascular Science, London, UK.
authors.forename: N
authors.identifier: 0000000324686804
authors.initials: N
authors.lastname: Finer
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: W P T
authors.initials: WP
authors.lastname: James
authors.affiliation: Special Vocational College for Handicapped Persons, Mainz, Germany.
authors.forename: U F
authors.initials: UF
authors.lastname: Legler
authors.affiliation: Catholic University of Rio de Janeiro and State Institute of Diabetes and Endocrinology, Rio de Janeiro, Brazil.
authors.forename: W
authors.initials: W
authors.lastname: Coutinho
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Sharma
authors.affiliation: Department of Diabetology, Metabolism and Clinical Nutrition, Antwerp University Hospital, Antwerp, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Van Gaal
authors.affiliation: Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy.
authors.forename: A P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: The Boden Institute of Obesity, Nutrition Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Sweeting
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
authors.forename: C
authors.identifier: 0000000328926131
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Gebski
authors.affiliation: The Boden Institute of Obesity, Nutrition Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: I D
authors.initials: ID
authors.lastname: Caterson
mesh_terms: D000368:Aged; D001067:Appetite Depressants / Q000008:administration & dosage*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D003503:Cyclobutanes / Q000008:administration & dosage*; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D015431:Weight Loss
chemical_list: D001067:Appetite Depressants; D003503:Cyclobutanes; C058254:sibutramine