title: Drug-Induced- or Rheumatic- Valvular Heart Disease in Patients Exposed to Benfluorex?
abstract: There is a risk of misdiagnosis between benfluorex-induced VHD and acute rheumatic fever (ARF)-related VHD due to common characteristics of both etiologies. We aimed at estimating the probability for a patient exposed to benfluorex presenting with VHD to have, at the same time, a history of ARF-related VHD. Such epidemiological approach could help at reducing the risk of misdiagnosis. We used INSEE data and related literature as well as various modeling hypotheses to drive and test a formula for calculating the probability of a patient presenting with VHD and a history of benfluorex intake to have a prior history of ARF-related VHD. Different scenarios were estimated by a Markov model on the life course of people born in France between 1940 and 1960. Sensitivity analyses were performed under these scenarios. According to the different scenarios and gender, the probability that a patient born between 1940 and 1960 presenting with VHD and a history of benfluorex intake would have had a prior history of ARF-related VHD varied from 0.2% to 2.7%. The probabilities by the year of birth were as follows: 0.8%-2.7% for a patient born in 1940, < 0.5% in all scenarios for patients born after 1955, and < 0.2% in all scenarios for patients, born in 1960. Our results indicate that the burden of ARF-related VHD is low in the patient population exposed to benfluorex. The probability of ARF related VHD should not be over-estimated in the diagnostic procedure of VHD.
authors.affiliation: Service de Cardiologie, Hôpital de la Cavale Blanche CHRU Brest, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Le Ven
authors.affiliation: Université Européenne de Bretagne, Université de Brest, INSERM CIC 1412, CHRU Brest, France.
authors.forename: Zarrin
authors.initials: Z
authors.lastname: Alavi
authors.affiliation: Service de Cardiologie, Hôpital de la Cavale Blanche CHRU Brest, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Jobic
authors.affiliation: Service de Cardiologie, Hôpital de la Cavale Blanche CHRU Brest, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Etienne
authors.affiliation: Service de Cardiologie, Hôpital de la Cavale Blanche CHRU Brest, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Didier
authors.affiliation: Assistance Publique Hôpitaux de Paris, Hotel-Dieu, Centre d'Epidémiologie Clinique, Université Paris Descartes, Inserm U1153, Paris, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
mesh_terms: D000368:Aged; D001067:Appetite Depressants / Q000009:adverse effects*; D005260:Female; D005277:Fenfluramine / Q000009:adverse effects / Q000031:analogs & derivatives*; D005602:France / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D012214:Rheumatic Heart Disease / Q000139:chemically induced* / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D001067:Appetite Depressants; D005277:Fenfluramine; C001584:benfluorex