Does smoking cessation with varenicline worsen vascular endothelial function?

Abstract

ObjectivesA meta-analysis suggested that the use of varenicline, which is a partial agonist of nicotinic acetylcholine receptors and is effective in smoking cessation, increases the risk of cardiovascular events within 52 weeks of starting treatment. Defining these events as occurring during drug treatment (usually for 12 weeks) or within 30 days of discontinuation, another meta-analysis showed that the risk was statistically insignificant. In the present study, we aimed to clarify the effect of varenicline-assisted smoking cessation on vascular endothelial function assessed by flow-mediated vasodilation (FMD).DesignBefore–after and time-series.SettingTochigi Prefecture, Japan.ParticipantsData of 85 participants who visited nicotine-dependent outpatient services were reviewed. FMD was repeatedly measured in 33 of the 85 participants. Inclusion criteria: 20 years and older, Brinkman index ≥200, Tobacco Dependence Screener ≥5 and stated motivation to quit smoking.InterventionsEach participant was treated with varenicline titrated up to 1.0 mg twice daily (for 12 weeks in total).Primary and secondary outcome measuresParticipants were evaluated by FMD prior to, and 3 months after, complete smoking cessation. Follow-up FMD measurements were carried out every 3 months if possible. Changes in FMD during varenicline use were also evaluated.ResultsFMD was significantly increased from 4.0±1.8% to 5.5±2.2% (p<0.01, n=22) 3 months after complete cessation. Although the timecourse of FMD in most of the cases showed an increase with fluctuations, there was an exceptional case where FMD decreased over the 9 months following complete cessation. Although statistically insignificant, FMD also increased during varenicline use (from 3.7±2.7% to 4.3±2.8%, n=11).ConclusionsOur observations suggest that in ceasing smokers, varenicline and smoking cessation do not lead to a worsening of the vascular endothelial function.Trial registrationFK-79 (International University of Health and Welfare).

Varenicline-assisted smoking cessation decreases oxidative stress and restores endothelial function

“…As we previously reported, 11 each subject was treated with varenicline titrated up to 1.0 mg twice daily (0.5 mg once a day for the first 3 days, 0.5 mg twice a day for next 4 days and 1.0 mg twice a day for 11 weeks). The target smoking cessation date was planned to be within 7 days after the initiation of varenicline.…”

“…10 Recently, we reported that varenicline-assisted smoking cessation improved vascular endothelial function in patients with hypertension, diabetes and/or dyslipidemia who were eager to quit smoking. 11 However, we did not focus on the association between endothelial function and oxidative stress in that study. In the present study, we aimed to clarify whether varenicline-assisted smoking cessation worsens or improves oxidative stress as well as vascular endothelial function.…”

Smoking cessation in Asians: focus on varenicline

“…The observations suggest that in ceasing smokers, varenicline and smoking cessation do not lead to worsening of the vascular endothelial function. 46 Within the Asian population, there have been no reports of varenicline being associated with increasing serious cardiovascular AEs, 22 – 29 though further trials are needed to confirm this.…”

Establishment of epigenetic markers to predict irradiation efficacy against oropharyngeal cancer

“…We collected the following clinicopathological factors for all the patients enrolled in this study: age, gender, tumor site, HPV‐L1 status, clinical stage (T, N, stage based on UICC 8th edition), Brinkman index of 200 as smoking behavior, irradiation dose and combination chemotherapy (Table ). The 40 specimens of the training set were collected during biopsies performed before treatment, immediately frozen in liquid nitrogen and stored at −80°C.…”