The Pharmaceutical Journal
Vol 275 No 7379 p716
10 December 2005

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Beneficial effects of rimonabant on cardiovascular risk confirmed

The beneficial effects of anti-obesity drug rimonabant on metabolic risk factors for cardiovascular disease have been confirmed in a trial published last month (New England Journal of Medicine 2005;353:2121).

The RIO-Europe (Rimonabant in Obesity Europe) study (PJ, 4 September 2004, p305) showed that rimonabant induces weight loss and improves metabolic risk factors for diabetes and cardiovascular disease in patients recruited on the basis of excess weight. The more recent study, called RIO-Lipid (Rimonabant in Obesity Lipid), enrolled people at higher risk of cardiovascular disease and looked at the effects of rimonabant on key metabolic risk markers for cardiovascular disease. RIO-Lipid involved 1,036 patients who were given either placebo, rimonabant 5mg daily or rimonabant 20mg daily, all for 12 months in addition to a hypocalorific diet. Drop-out rates were around 40 per cent in all three groups.

Compared with placebo, rimonabant 20mg per day induced significant weight loss and reduction in waist circumference, say the researchers. In addition, it reduced plasma triglycerides, increased high-density lipoprotein (HDL) cholesterol level and improved the total cholesterol:HDL cholesterol ratio. It had no effect on low-density lipoprotein (LDL) cholesterol levels but changed the LDL particle size. It also increased adiponectin levels to an extent that could not be attributed to weight loss alone. “A high adiponectin level has been reported to be predictive of a reduced risk of diabetes and cardiovascular events,” say the researchers. C-reactive protein levels were also reduced.

The authors conclude that CB1-receptor blockade may constitute a new, clinically relevant pharmacological approach to improve unfavourable cardiovascular risk profile in high-risk patients with dyslipidemia who are overweight or obese.

The author of an editorial in the same issue (p2187) points out that patients with co-existing conditions, such as diabetes and psychiatric disorders, were excluded from the trial thus limiting its generalisability.