Abstract
Nicotine patches are commonly used by people who try to quit smoking. Because high doses of nicotine may increase heart rate and potentiate cardiac arrhythmia or ischemia, its use in patients with coronary artery disease was investigated. The objective was to assess the cardiovascular safety of nicotine patches in patients with coronary artery disease (CAD) who try to quit smoking. The study was conducted in a double-blind, placebo-controlled, randomized fashion over a 2-week period. One hundred and six patients with CAD who wished to stop smoking and were taking part in a smoking cessation program were included. Fifty-two patients received nicotine patches (Nicotinell®) and 54 received placebo patches. The cardiovascular effects of nicotine patches were assessed by repeated ambulatory ECG monitoring (AEM) and exercise testing. There were no changes in the resting heart rate and in the systolic or diastolic blood pressure between the screening and the two phases of the study in both the Nicotinell and placebo groups. Repeated 48-hour AEM revealed that there were no significant changes in the number and duration of ischemic episodes in both groups. There was no change in the frequency of atrial or ventricular arrhythmias. Exercise duration and time to 1-mm ST-segment depression increased in both groups during the double-blind treatment phase. More patients in the Nicotinell group claimed tobacco abstinence compared with the placebo group (27% vs. 13%). The use of nicotine patches did not cause aggravation of myocardial ischemia or arrhythmia in coronary patients and therefore can be used as a method to promote smoking cessation in this high-risk group.
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References
U.S. Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction, A Report of the Surgeon General 1988. Rockville, MD: Office on Smoking and Health, DHSS Publication no. (CDC) 88-8406.
U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress, A Report of the Surgeon General 1989. Rockville, MD: Office on Smoking and Health, DHSS Publication no. (CDC) 89-8411.
Siegel D, Grady D, Browner WS, Hulley SB. Risk factor modification after myocardial infarction. Ann Intern Med 1988;109:213-218.
Sparrow D, Dawber TR, Colton T. The influence of cigarette smoking on prognosis after a first myocardial infarction: A report from the Framingham Study. J Chronic Dis 1978;31:425-432.
Daly LE, Mulcahy R, Graham IM, Hickey N. Long term effect on mortality of stopping smoking after unstable angina and myocardial infarction. Br Med J 1983;287:324-326.
Hedback B, Perk J. Five-year results of a comprehensive rehabilitation programme after myocardial infarction. Eur Heart J 1987;8:234-242.
AHA Consensus Panel Statement. Preventing heart attack and death in patients with coronary disease. J Am Coll Cardiol 1995;26:292-294.
Tonnesen P, Norregaard J, Simonsen K, Sawe U. A double-blind trial of a 16-hour transdermal nicotine patch in smoking cessation. N Engl J Med 1991;325:311-315.
Transdermal Nicotine Study Group. Transdermal nicotine for smoking cessation. JAMA 1991;266:3133-3138.
Jorenby DE, Smith SS, Fiore MC, et al. Varying nicotine patch dose and type of smoking cessation counselling. JAMA 1995;274:1347-1352.
Dale LC, Hurt RD, Offord KP, Lawson GM, Croghan IT, Schroeder DR. High-dose nicotine patch therapy. JAMA 1995;274:1353-1358.
Kozak J, Fagerström K, Sawe U. High-dose treatment with the nicotine patch. Int J Smoking Cessation 1995;4:26-28.
Krumholz HM, Cohen BJ, Tsevat J, Pasternak RC, Weinstein MC. Cost-effectiveness of a smoking cessation program after myocardial infarction. J Am Coll Cardiol 1993; 6:1697-1702.
Joseph AM, Norman SM, Ferry LH, et al. The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease. N Engl J Med 1996;335: 1792-1798.
Khoury Z, Comans P, Keren A, Lerer T, Gavish A, Tzivoni D. Effects of transdermal nicotine patches on ambulatory ECG monitoring findings: A double-blind study in healthy smokers. Cardiovasc Drugs Ther 1996;10:179-184.
Fagerström KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav 1978;3:235-241.
Draize JH, Woodward G, Calvery HO. Methods of the study of initiation and toxicity of substances applied topically to the skin and mucous membranes. J Pharmacol Therap 944;82:377-419.
Silagy C, Mant D, Fowler G, Lodge M. Meta-analysis on efficacy of nicotine replacement therapies in smoking cessation. Lancet 1994;343:139-142.
Fiore MC, Kenford SL, Jorenby DE, Wetter DW, Smith SS, Baker TB. Two studies of the clinical effectiveness of the nicotine patch with different counseling treatment. Chest 1994;105:524-533.
Hughes JR. Combined psychological and nicotine gum treatment for smoking: A critical review. J Subst Abuse 1991;3:337-350.
Grunberg NE, Popp KA, Bowen DJ, et al. Effects of chronic nicotine administration on insulin, glucose, epinephrine and norepinephrine. Life Sci 1988;42:161-170.
Transdermal Nicotine Study Group. Transdermal nicotine for smoking cessation: Six-month results from two multicenter controlled clinical trials. JAMA 1991;266:3133-3138.
Sachs DPL, Sawe U, Leischow SJ. Effectiveness of a 16-hour transdermal nicotine patch in a medical practice setting, without intensive group counselling. Arch Intern Med 1993;153:1881-1890.
Hurt RD, Dale LC, Fredrickson PA, et al. Nicotine patch therapy for smoking cessation combined with physician advice and nurse follow-up: One-year outcome and percentage of nicotine replacement. JAMA 1994;271:595-600.
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Tzivoni, D., Keren, A., Meyler, S. et al. Cardiovascular Safety of Transdermal Nicotine Patches in Patients with Coronary Artery Disease who Try to Quit Smoking. Cardiovasc Drugs Ther 12, 239–244 (1998). https://doi.org/10.1023/A:1007757530765
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DOI: https://doi.org/10.1023/A:1007757530765