Prescribing Advice for GPs

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Rimonabant ineffective in halting CHD progression

The Journal of the American Medical Association has published the results of a study that aimed to determine whether weight loss and metabolic effects of the rimonabant reduced progression of coronary heart disease (CHD) in patients with abdominal obesity and metabolic syndrome.

The study recruited 839 patients who received dietary counselling and rimonabant 20mg daily or matching placebo for a period of 18 months. 676 patients underwent baseline and completion intravascular ultrasonography to assess changes in atheroma volume.

The primary outcome was not significant (p=0.22); rimonabant produced a +0.25% change in atheroma volume while placebo produced a +0.51% change. A secondary outcome of normalised atheroma volume was significantly different but this difference should be viewed with caution because the primary outcome was not statistically different.

The authors of the paper conclude that, "determining whether rimonabant is useful in management of coronary disease will require additional imaging and outcomes trials".

Action: Clinicians should not use rimonabant in preference to other anti-obesity drugs on the presumption that reductions on some cardiometabolic risk factors will translate to reductions in cardiovascular morbidity and mortality.

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