Valvular heart disease associated with benfluorex therapy: high prevalence in patients with unexplained restrictive valvular heart disease

Eur J Echocardiogr. 2011 Sep;12(9):688-95. doi: 10.1093/ejechocard/jer116. Epub 2011 Aug 2.


Aims: Restrictive valvular disease (RVD) has recently been reported in patients after benfluorex exposure. However, little is known about its prevalence and echocardiographic features. The aim of our study was to assess the frequency of benfluorex exposure in patients with RVD and to describe their echocardiographic characteristics.

Methods and results: In a single centre study, patients with a final diagnosis of unexplained RVD were studied. Patients were interrogated for their previous use of benfluorex or other appetite-suppressant drugs (ASDs). Forty seven consecutive patients, aged 59 ± 9.6 years, with RVD were found [42 (91%) women]. Among them, 35 (74%) had previous treatment with ASD, including benfluorex in 34 patients. Among the latter, 14 (40%) have been exposed to benfluorex alone, 20 (60%) in combination with another ASD. Echocardiographic features included isolated mitral or aortic restricted valve motion in 19 patients (40%), and combined mitral and aortic involvement in 28 (60%).Twenty-seven (96%) of the latter had been exposed to benfluorex. As compared with the 'no ASD' group (n= 12), patients in the benfluorex group (n= 34) were more frequently female, had more frequent arterial hypertension and hypertriglyceridemia, and presented more frequently with combined mitral and aortic disease (79 vs. 8%, P < 0.001). Valve stenosis and tricuspid involvement were rare in the benfluorex group.

Conclusion: The frequency of benfluorex exposure is high in patients with unexplained RVD. Combined aortic and mitral restrictive valve regurgitation is highly suggestive of valvular disease associated with benfluorex or other ASD therapy and may alert clinician about the possibility of this diagnosis.

MeSH terms

  • Aortic Valve* / diagnostic imaging
  • Appetite Depressants / adverse effects*
  • Echocardiography, Doppler
  • Female
  • Fenfluramine / adverse effects
  • Fenfluramine / analogs & derivatives*
  • Heart Valve Diseases / chemically induced*
  • Heart Valve Diseases / diagnostic imaging
  • Humans
  • Hypolipidemic Agents / adverse effects
  • Male
  • Middle Aged
  • Mitral Valve* / diagnostic imaging


  • Appetite Depressants
  • Hypolipidemic Agents
  • Fenfluramine
  • benfluorex