Obesity is associated with the development and progression of multiple cardiovascular
risk factors, such as hypertension, dyslipidemia, and type 2 diabetes mellitus, and
is an important contributor to the global burden of atherosclerotic cardiovascular
disease (CVD). Guidelines suggest that clinicians provide lifestyle counseling and
promote lifestyle modifications before considering weight-loss surgery. However, despite
lifestyle modifications and increased physical activity, most patients with obesity
will not lose significant weight or will experience weight regain. Weight-loss pharmacotherapy
added to lifestyle modification has long been perceived as a bridge between lifestyle
modifications alone and weight-loss surgery. However, since its inception, weight-loss
pharmacotherapy has been plagued by variable efficacy and concern about cardiovascular
safety. Following requirements from regulatory authorities, efficacy and cardiovascular
safety trials have been conducted for the currently available weight-loss pharmacotherapeutic
agents. Overall, these trials have shown that weight-loss pharmacotherapy is only
modestly efficient for the inducement of weight loss. Recent trials have also demonstrated
the cardiovascular safety of some of these agents. We review these trials with a focus
on the clinical impact of these weight-loss pharmacotherapeutic agents in patients
with atherosclerotic CVD.
