Smoking Cessation Therapies Safe for CV Patients

According to a recent meta-analysis of randomized controlled trials, smoking cessation therapies are not associated with an increased risk for serious cardiovascular events.

Researchers from the Stanford Prevention Research Center at Stanford University School of Medicine, the University of Ottawa, and McMaster University examined 63 randomized controlled trials that assessed varenicline, bupropion, or nicotine replacement therapy in approximately 30,000 participants.

After a median of 12 weeks of treatment and 12 months of follow-up, investigators found bupropion and varenicline were not linked to an increased cardiovascular risk. Replacement therapy was connected to a greater risk for all cardiovascular events in comparison to a placebo (relative risk, 2.29), but study authors note that most of this risk can be explained by lower-level CV events, such as tachycardia and arrhythmia.

In addition, bupropion was associated with a reduced risk for the combined outcome of stroke, myocardial infarction, and cardiovascular death. The finding that smoking cessation therapies are not connected to cardiovascular risks and should be considered safe for most patients “should be of interest to both clinicians and the public,” says Edward Mills, MD, associate professor of medicine at Stanford University School of Medicine and co-author of the study.

“There is some reason to believe that treatment effects will vary for certain patients, and so individuals with an elevated cardiovascular risk profile may want to be cautious with nicotine replacement therapy, and instead consider bupropion or varenicline,” says Mills.

“Among patients with established cardiovascular disease, bupropion—while less effective for smoking cessation than varenicline or nicotine replacement therapy—may have a protective role for cardiovascular events.” The findings originally appeared in the December issue of Circulation.

—Mark McGraw

Reference

Mills E, Thorlund K, et al. Cardiovascular Events Associated with Smoking Cessation Pharmacotherapies: A Network Meta-Analysis. Circulation. 2013.