The American Heart Association has issued recommendations that are similar to advice provided in the Harvard Heart Letter (December 1997).

The AHA statement acknowledges that very little is known about how common the heart problems caused by the diet medications truly are and which patients are at greatest risk for these problems. Furthermore, it is not known if the valve abnormalities are reversible after patients stop taking the drugs or if people who took these medications but show no evidence of heart disease need to be checked for such problems far into the future.

Accordingly, the American Heart Association recommends that people who have used Adipex see their physicians and be examined. In most cases, the examination will show no evidence of valvular heart disease. People who have symptoms or heart murmurs that suggest heart-valve abnormalities should undergo an echocardiogram--a test that uses sound waves to reveal the heart's structures.

Even if abnormalities of heart valves are detected, it does not mean that the medication caused the problem or that the abnormal heart valves need to be replaced. However, people with such abnormalities should be followed more closely by their physicians and should use antibiotics before dental work to reduce their risk of heart-valve infection (endocarditis).

The FDA recommends an echocardiogram for patients who have no symptoms of valve problems, but who are scheduled for a procedure that may introduce bacteria into the bloodstream (such as dental work), so that they may take antibiotics prior to the procedure. The echocardiogram can confirm whether such preventive treatment is needed.

How long do doctors and patients need to watch for evidence of valve problems in Adipex patients ? No one knows.

The total number of prescriptions for Adipex in the United States exceeded 18 million, and the worldwide use of this drug is undoubtedly much greater. So far, only a small number of patients have required surgery because of the heart-valve damage attributed to this medication. It is possible that the complication rate may remain low. However, it may take several years before the true impact of this human-made epidemic is known.