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Dexfenfluramine and heart-valve regurgitation
in Chinese patients with type 2 diabetes
GTC Ko, HCK Chan, CC Chow
Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai
Po, Hong Kong
OBJECTIVE. To assess whether valvular lesions are
associated with the use of dexfenfluramine in Chinese patients with
type 2 diabetes.
DESIGN. Case-control study.
PATIENTS AND METHODS. Thirty-six obese Chinese patients
with type 2 diabetes and a history of dexfenfluramine use during
the period January 1992 and September 1997 were recruited into the
study, while another 43 age- and sex-matched Chinese patients with
type 2 diabetes were recruited as controls. The mean age for the
cases was 44.1 years (standard deviation, 11.2 years; median, 42.5
years; range, 20-64 years). The 43 control subjects were age- and
sex-matched, and had a mean age of 48.5 years (standard deviation,
10.9 years; median, 51.0 years; range, 16-63 years; P>0.05).
The male-to-female ratio was confirmed as similar between the two
groups (10:26 versus 12:31; P>0.05). All patients were clinically
free from cardiovascular disease. Patients with a history of underlying
valvular disease from any cause were excluded from the study. All
patients underwent echocardiographic assessment, and the presence
of any valvular lesions was documented.
RESULTS. The mean duration of dexfenfluramine use
by the cases was 21.8 weeks (standard deviation, 29.0 weeks; median,
18.0 weeks; range, 1-160 weeks). Subjects with a history of dexfenfluramine
use had higher rates of ignificant
aortic regurgitation, tricuspid regurgitation of any severity, and
of any valvular regurgitation, compared to controls (11.1% versus
0%, P<0.05; 30.6% versus 4.7%, P<0.01; and 61.1% versus 34.9%,
P<0.05, respectively). Logistic stepwise regression analysis
to predict the risk of valvular lesion was conducted, with age,
sex, history of dexfenfluramine use, body mass index, waist-hip
ratio, blood pressure, fasting plasma glucose, lipid profile, and
duration of diabetes as independent variables. A history of dexfenfluramine
use was the only significant parameter entered into the model (significant
aortic regurgitation: beta=9.19, standard error=46.6, P<0.05;
any tricuspid regurgitation: beta=2.76, standard error=10.8, P<0.05).
CONCLUSION. In Chinese patients with type 2 diabetes,
a history of dexfenfluramine use is associated with heart-valve
regurgitation, particularly aortic regurgitation.
Hong Kong Med J 2003;9:243-6
Key words: Chinese; Dexfenfluramine; Diabetes mellitus;
Heart valves
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