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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.

A systematic review of possible serious adverse health effects of nicotine replacement therapy

“…Four clinical trials of patients with cardiac disease also provided relevant data (CAFs 27, 28A, 29 and 30A). Three trials (Joseph et al 1996; Rennard et al 1994; Tzivoni et al 1998) were double-blind RCTs of nicotine patches, ascribed a “low” risk of bias. The other (Mohiuddin et al 2007), ascribed a “high” risk of bias, was less informative, only providing results relevant to the effects of an intensive intervention with individualized pharmacotherapy, which only included NRT for some patients, results not being separately presented for those prescribed NRT.…”

Brief exposure to Swedish snus causes divergent vascular responses in healthy male and female volunteers

“…It may also account for that discontinuation of snus following myocardial infarction reduces mortality by almost fifty per cent [ 9 ]. On the other hand, nicotine replacement therapy (NRT) does seem to be safe following myocardial infarction and it has not been shown to increase the risk for cardiovascular disease during a follow-up period of 12 months [ 43 , 44 ]. One possible explanation may be that Swedish snus generally has a pH in the range of 7.8–8.5 (compared to an average pH of 5.3 in cigarette smoke) [ 45 , 46 ].…”

The Effects of Transdermal Nicotine Patches on the Cardiorespiratory and Lactate Responses During Exercise from Light to Moderate Intensity: Implications for Exercise Prescription during Smoking Cessation

“…In particular, TNPs are easy to use and provide a slow, steady level of nicotine over a long period as compared to nicotine gum [7]. Furthermore, TNPs can be applied safely in normal individuals [8,9] and various populations (e.g., patients with cardiac disease, pregnant women) [10,11] using low or high nicotine doses.…”