21st-Century Hazards of Smoking and Benefits of Cessation in the United States

Jha, Prabhat; Ramasundarahettige, Chinthanie; Landsman, Victoria; Rostron, Brian L.; Thun, Michael J.; Anderson, Robert N.; McAfee, Tim; Pető, Richárd

doi:10.1056/nejmsa1211128

Cited by 1,509 publications

(850 citation statements)

References 15 publications

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“…Given this, it appears unlikely that varenicline would increase cardiovascular risk through its activation of nAchRs, and if possible, the occurrence of such events would be extremely rare. This potential risk must also be considered in the context of the exceptional role of quitting smoking in reducing cardiovascular risk 59, 60. The cardiovascular benefits of varenicline as an efficacious smoking‐cessation pharmacotherapy61 far outweigh a speculative and extremely small potential increase in cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Sterling

Windle

Filion

et al. 2016

JAHA

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BackgroundVarenicline is an efficacious smoking‐cessation drug. However, previous meta‐analyses provide conflicting results regarding its cardiovascular safety. The publication of several new randomized controlled trials (RCTs) provides an opportunity to reassess this potential adverse drug reaction.Methods and ResultsWe searched MEDLINE, EMBASE, and the Cochrane Library for RCTs that compare varenicline with placebo for smoking cessation. RCTs reporting cardiovascular serious adverse events and/or all‐cause mortality during the treatment period or within 30 days of treatment discontinuation were eligible for inclusion. Relative risks (RRs) with 95% CIs were generated by using DerSimonian–Laird random‐effects models. Thirty‐eight RCTs met our inclusion criteria (N=12 706). Events were rare in both varenicline (57/7213) and placebo (43/5493) arms. No difference was observed for cardiovascular serious adverse events when comparing varenicline with placebo (RR 1.03, 95% CI 0.72–1.49). Similar findings were obtained when examining cardiovascular (RR 1.04, 95% CI 0.57–1.89) and noncardiovascular patients (RR 1.03, 95% CI 0.64–1.64). Deaths were rare in both varenicline (11/7213) and placebo (9/5493) arms. Although 95% CIs were wide, pooling of all‐cause mortality found no difference between groups (RR 0.88, 95% CI 0.50–1.52), including when stratified by participants with (RR 1.24, 95% CI 0.40–3.83) and without (RR 0.77, 95% CI 0.40–1.48) cardiovascular disease.ConclusionsWe found no evidence that varenicline increases the rate of cardiovascular serious adverse events. Results were similar among those with and without cardiovascular disease. Given varenicline's efficacy as a smoking cessation drug and the long‐term cardiovascular benefits of cessation, it should continue to be prescribed for smoking cessation.

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Section: Discussionmentioning

confidence: 99%

Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Sterling

Windle

Filion

et al. 2016

JAHA

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“…Understanding and preventing or reversing the escalation and entrenchment of cigarette smoking in the young adult years is critically important to reducing smoking's long-term health toll (Doll et al 2004(Doll et al , 2005Jha et al 2013;Pirie et al 2013; U.S. Department of Health and Human Services 2014). However, current tobacco control efforts may be missing the mark when one considers the complexity of patterns of young adult tobacco use, including the phenomenon of initiation starting after age 18.…”

Section: Prevescalation As a Research Gap And An Intervention Opportumentioning

confidence: 99%

Preventing Smoking Progression in Young Adults: the Concept of Prevescalation

et al. 2018

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As adolescents cross the threshold to young adulthood, they encounter more opportunities to engage in or accelerate previously discouraged or prohibited behaviors. Young adults, therefore, are more apt to initiate cigarette smoking and, more importantly, to accelerate their use if they tried and experimented as an adolescent. Preventing the escalation and entrenchment of smoking in the young adult years is critically important to reducing tobacco's long-term health toll. However, traditional interventions for youth have focused on preventing smoking initiation, and interventions for adults have focused on smoking cessation; both have failed to address the needs of young adults. We introduce the concept of Bprevescalation^to capture the need and opportunity to prevent the escalation of risk behaviors that typically occur during young adulthood, with a focus on the example of cigarette smoking. Prevescalation negates the notion that prevention has failed if tobacco experimentation occurs during adolescence and focuses on understanding and interrupting transitions between experimentation with tobacco products and established tobacco use that largely occur during young adulthood. However, since risk behaviors often co-occur in young people, the core concept of prevescalation may apply to other behaviors that co-occur and become harder to change in later adulthood. We present a new framework for conceptualizing, developing, and evaluating interventions that better fit the unique behavioral, psychosocial, and socio-environmental characteristics of the young adult years. We discuss the need to target this transitional phase, what we know about behavioral pathways and predictors of cigarette smoking, potential intervention considerations, and research challenges.

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“…28 Among HIV patients, quitting smoking also appears to convey substantial health benefits. For example, Lifson et al 26 reported that mortality among HIV patients in their sample was significantly higher throughout the follow-up period for current smokers than for former smokers.…”

Section: Health Benefits Of Quitting Smokingmentioning

confidence: 99%

Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis

Ledgerwood

Yskes

2016

NICTOB

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Introduction: People living with HIV/AIDS (PLWHA) are more likely to smoke cigarettes than are individuals in the general population. The health implications of tobacco use are substantially more dire among PLWHA than among otherwise healthy smokers, including higher rates of various cancers, cardiovascular disease, inflammation, and lung infections. Efficacious behavioral and medication treatments for treating nicotine dependence have rarely been investigated in PLWHA. Methods: We present a review of studies examining the efficacy of smoking cessation interventions. Results and Conclusions:The literature reveals some limited evidence for the efficacy of behavioral interventions. However, the research literature on these interventions is sparse and the efficacy findings are mixed. Studies exploring the use of mobile technologies for reducing treatment barriers are becoming more prevalent. Few published trials have directly examined the efficacy of pharmacological smoking cessation interventions among PLWHA. Specific gaps in the treatment literature are discussed in detail, and a strategy is presented for developing a greater understanding of factors that contribute to the efficacy of smoking cessation among PLWHA. Implications: This paper provides the most comprehensive review to date on smoking cessation intervention research conducted with PLWHA. It also discusses specific gaps in the literature that should be a priority for future research.

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21st-Century Hazards of Smoking and Benefits of Cessation in the United States

Abstract: Smokers lose at least one decade of life expectancy, as compared with those who have never smoked. Cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90%.

Cited by 1,509 publications

References 15 publications

Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Preventing Smoking Progression in Young Adults: the Concept of Prevescalation

Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis

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