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Questions
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Do the INTERHEART interventions eliminate or just postpone the occurrence of cardiovascular complications?
Professor David Wood: INTERHEART, as an epidemiological study, was not an intervention trial. However, the results indicate that adopting a healthy lifestyle will reduce an individual's risk of developing myocardial infarction by 
80%. Intervention trials have shown, for example, that it is possible to reduce the risk of cardiovascular disease by blood pressure lowering or lipid lowering. These trials have been short-term, up to 6 years, because it is considered unethical to continue a clinical trial when there is a clear evidence of benefit for a given treatment. We do not know whether continuation of these treatments to over 10–15 years will simply postpone the development of atherosclerosis or eliminate the disease entirely, in other words, we will die of something else. However, the expectation from projecting the trial results is that there will be a real reduction, or prevention, of atherosclerosis.
What about the possible favourable effects of fish oil on lipids, and what about ezetimibe?
Professor Eric Bruckert: Ezetimibe is an interesting drug,
Will statins become the aspirin of the diabetic patient?
How should we screen for depression, which was a risk factor in INTERHEART?
The five components of the metabolic syndrome are all within the nine factors in INTERHEART. Would you advise patients with metabolic syndrome to take aspirin?
Why would one have to lose >10% of body weight to reduce mortality when a lesser loss will already reduce cardiovascular risk factors?
How should we screen for the secondary causes for obesity such as Cushing's disease?
Despite a large number of obese patients having diabetes, hypertension, metabolic syndrome, and so on, there are many obese people without any health problems. What should we do about the so-called healthy obese subjects?
The Look AHEAD study is an ambitious project being undertaken in one of the most obesogenic environments (the US). What tips do you have for helping patients to adhere to a lifestyle modification programme?
In view of the different mechanisms of actions of the different weight-reducing agents, would it be logical to combine them?
Is it possible to give sibutramine with an agent such as fluoxetine?
For how long should sibutramine be given?
As a cardiologist with patients similar to those entered into the SCOUT trial, the average number of drugs my patients are on is anything from 6 to 13. Is there any information on drug–drug interactions with sibutramine?
If the blood pressure actually falls with sibutramine, does it need monitoring?
Why are anti-obesity drugs so expensive?
Bariatric surgery is now very much improved. Is this a more realistic option for very obese patients?
How can we help patients to accept that they only need to lose 5–10% of their body weight when they want to lose much more and how do we help them to comply with weight management?
For which patients would you prescribe sibutramine?
In view of the effect of sibutramine on heart rate and blood pressure, is it possible to give it together with a beta-blocker?
What is the effect of sibutramine on binge eating if it has this satiety effect?
When will we have the final results of SCOUT?