Review of Cigarette Smoking Management in Cardiovascular Patients

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    Nahid Edrisi1, Bahare Oji2 

    1. Resident of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran
    2. Psychiatrist, psychosomatic fellowship, Shiraz University of Medical Sciences, Shiraz,Iran

    More than 1.1 million people in North America experienced MI, more than 20% of whom are smokers.

    Smoking causes atherosclerosis and increases the risk of death, myocardial infarction, angina, peripheral vascular disease, and stroke. Smoking cessation is an urgent issue in cardiovascular disease. 

    1) Nicotine replacement therapy (NRT) which includes chewing gum, skin patch, and inhaler.

    2) Non-nicotine replacement therapy (non NRT) which includes bupropion, varenicline, and counseling.

    Previous research has shown that nicotine gum and skin patches do not cause platelet aggregation and thrombotic CVD, do not increase ischemia and are known to be safe. But because research has not been reviewed in the first few weeks after MI, guidelines recommend that NRT should be given with caution, especially in the first two weeks after MI. Another article states that although NRT is safer than cigarettes, there are a number of concerns, including smoking while using a nicotine patch. Additionally nicotine patches preferred due to slower nicotine release and lower concentrations than other NRT methods.

    In the United States, Bupropion (SR) was registered as a smoking cessation treatment in 1997 and was recognized as a first-line treatment in 2001. An important cardiac complication of bupropion is a sympathomimetic activity, including high blood pressure and increased heart rate. Generally, the articles state that it does not increase the risk of cardiovascular complications and mentioned that it can be used safely in the first two weeks after a heart attack.

    Varenicline is a selective, partial nicotinic receptor agonist that is as effective as NRT but more effective than bupropion. Previous articles reported chances of varenicline cardiovascular complications, although recent studies reported the same complications as bupropion. The chance of cardiovascular complications has also been ruled out by the FDA.

    Refrences:

    Sharma A, Thakar S,Lavie CJ,Garg J, Krishnamoorthy P, Sochor O,et al. Cardiovascular Adverse Events Associated with Smoking-Cessation Pharmacotherapie. Curr Cardiol Rep.2015;17:554.

    Ludvig J, Miner B, Eisenberg MJ. Smoking cessation in patients with coronary artery disease. Am Heart J. 2005 Apr;149(4):565-72.

    McRobbie H, Hajek P. Nicotine replacement therapy in patients with cardiovascular disease: guidelines for health professionals. Addiction. 2001 Nov;96(11):1547-51.

    Monárrez-Espino J, Galanti MR, Hansson J, Janszky I, Söderberg-Löfdal K, Möller J. Treatment With Bupropion and Varenicline for Smoking Cessation and the Risk of Acute Cardiovascular Events and Injuries: a Swedish Case-Crossover Study. Nicotine Tob Res. 2018 Apr 2;20(5):606-613.

    Suissa k, Larivière J, Eisenberg MJ, Eberg M, Gore GC, Grad R,et al. Efficacy and Safety of Smoking Cessation Interventions in Patients With Cardiovascular Disease: A Network Meta-Analysis of Randomized Controlled Trials. Circ Cardiovasc Qual Outcomes. 2017 Jan;10(1).

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