Transdermal Nicotine in Patients with Cardiac Disease
Although nicotine therapy is established as an aid to smoking cessation, anecdotal reports of arrhythmia, MI, and stroke during nicotine therapy have made some clinicians wary of nicotine prescription in the face of underlying coronary heart disease. In a similar fashion, patients alarmed by media reporting of adverse events during treatment may avoid such modalities.
A group of 584 smoking patients with significant underlying heart disease was randomly assigned to receive transdermal nicotine therapy, in a typical 10-week stepwise dose-reduction format, or placebo. Subjects were monitored during and for four weeks after treatment. Primary end points were death, MI, cardiac arrest, hospital admission, arrhythmia, or CHF.
There was a trend toward fewer primary end points (5.4% vs 7.9%) in the nicotine group when compared with the placebo group. Deaths were more common in the placebo group (P > 0.05; NS).
The authors demonstrate that transdermal nicotine does not cause increased risk of cardiovascular events, even in high-risk patients with defined cardiac disease and those individuals who continue to smoke while using the nicotine patch.
Joseph AM, et al. N Engl J Med 1996;335:1792-1798.
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