Nicotine Patch Therapy in Smoking Cessation Reduces the Extent of Exercise-Induced Myocardial Ischemia

Mahmarian, John J.; Moyé, Lemuel A.; Nasser, George A; Nagueh, Sherif F.; Bloom, Myer; Benowitz, Neal L.; Verani, Mario S.; Byrd, William G; Pratt, Craig M.

doi:10.1016/s0735-1097(97)00128-9

Cited by 113 publications

(53 citation statements)

References 16 publications

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“…114 Finally, an experimental study showed that patients with severe coronary artery disease treated with transdermal nicotine, which suppressed but did not eliminate smoking, showed a substantial reduction in exerciseinduced myocardial perfusion defect size, as measured by quantitative thallium-201 single-photon emissioncomputed tomography. 115 Improved perfusion was noted despite a 2-fold increase in nicotine levels while using patches and smoking at the same time, compared with baseline smoking alone. It is likely that the improved perfusion was due to reduced exposure to carbon monoxide and other combustion products.…”

Section: Cardiovascular Effects Of Medicinal Nicotine In Clinical Trialsmentioning

confidence: 93%

Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment

Benowitz²,

et al. 2010

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on behalf of the American Heart Association Council on Cardiovascular Nursing V arious forms of smokeless tobacco (ST) products (snuff, chewing tobacco) are used by individuals of all ages. Over the past several years, US tobacco companies have expanded marketing and promotion of ST products. A major aim of this statement is to review and summarize the scientific evidence regarding ST product use and the potential cardiovascular risks associated with ST product use that can be used to inform policy related to tobacco control and strategies related to tobacco harm reduction. A specific policy question is whether ST products should be recommended to smokers instead of cigarettes to reduce the morbidity and mortality associated with smoking and/or as an approach to enhance smoking cessation. Although evidence is consistent with the suggestion that the cardiovascular risks are lower with ST products compared with cigarette smoking, ST products are not without harm. As reviewed in this statement, there is evidence that long-term ST product use may be associated with a modest risk of fatal myocardial infarction (MI) and fatal stroke, suggesting that ST product use may complicate or reduce the chance for survival after a MI or stroke. In addition, there is inadequate evidence to support the use of ST products as a smoking cessation strategy. Based on the findings reviewed in this statement, clinicians should continue to discourage use of all tobacco products and emphasize prevention of smoking initiation and smoking cessation as primary goals for tobacco control.In the United States, various forms of ST products (snuff, chewing tobacco) are used by individuals of all ages, including adolescents and young adults.

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Section: Cardiovascular Effects Of Medicinal Nicotine In Clinical Trialsmentioning

confidence: 93%

Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment

Benowitz²,

et al. 2010

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“…36 Improved perfusion imaging was noted in patients with severe coronary disease who reduced the number of cigarettes smoked when using transdermal nicotine. 37 Other controlled trials have also supported the safety of nicotine replacement therapy, which produced no increase in cardiovascular events even in patients with coronary artery disease. [38][39][40] Thus, it seems that tobacco is more harmful than pure nicotine, which may be the result of the presence of other substances, including nitrosamines, polycyclic aldehydes, and alkaloids.…”

Section: Smokeless Tobacco and Other Health Consequencesmentioning

confidence: 99%

Smokeless Tobacco and Cardiovascular Risk

2004

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This article discusses the evolution of smokeless tobacco in the United States and interprets the available data on cardiovascular risk factors and cardiovascular mortality associated with its use. There has been a resurgence of smokeless tobacco use since 1970. Smokeless tobacco consistently produces levels of nicotine higher than those seen with smoking and causes similar sympathetic neural stimulation and acute cardiovascular effects. However, there is conflicting evidence from prospective and case-control studies about cardiovascular mortality or myocardial infarction caused by smokeless tobacco use. Smokeless tobacco use is also associated with oral cancers and high-risk behavior in adolescents. Although the evidence is not conclusive, the adverse cardiovascular effects of smokeless tobacco use are less than those caused by smoking but are more than those found in nonusers. It is advisable to counsel all current users of smokeless tobacco to quit. Behavioral counseling, sustained-release bupropion hydrochloride therapy, and nicotine replacement therapy may be safe therapeutic modalities for treatment of smokeless tobacco use.

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“…Its proven efficacy makes NRT a first-intention SC aid, increasing the chances of success 1.5- to 2-fold [21,22]. Its cardiologic safety was highlighted by Mahmarian et al [27], who demonstrated a fall in the myocardial perfusion deficit on scintigraphy in patients undergoing SC under NRT as compared to their prior status as active smokers. Moreover, epidemiological studies showed an early cardiovascular benefit of SC, as smoke-free laws led to a rapid reduction in the incidence of myocardial infarction in the first 12 months [28].…”

Section: Discussionmentioning

confidence: 99%

Early Improvement in Peripheral Vascular Tone following Smoking Cessation Using Nicotine Replacement Therapy: Aortic Wave Reflection Analysis

Roux

Motreff

Perriot³

et al. 2010

Cardiology

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Objectives: Cigarette smoking induces cardiovascular pathology and worsens arterial stiffness. Arterial stiffness can be assessed noninvasively based on 2 indices: pulse-wave velocity (PWV), indicating aortic stiffness, and the augmentation index (AIx), indicating aortic wave reflection. The impact of smoking cessation (SC) with nicotine replacement therapies (NRT) on arterial stiffness remains unknown. Methods: AIx and PWV were studied prospectively (using a SphygmoCor system) in 26 long-term smokers (>10 cigarettes/day; mean age 43 ± 6 years) before (visit 1) and 28 and 56 days (visit 2 and visit 3) after SC supported by NRT. Abstinence was ascertained when exhaled carbon monoxide (CO) was <10 ppm; the quantity of NRT absorbed was assessed based on the serum cotinine level. Results: Sixteen of 24 patients (67%) were abstinent at the end of the study; 8/24 had cut down on smoking, and 2 were lost to follow-up. CO and serum cotinine levels fell after SC. The mean AIx for the population as a whole was 23.4% at visit 1, with a significant early reduction by visit 2 (16.2%) and visit 3 (13.9%) (ANOVA, p < 0.001). The PWV, peripheral blood pressure, and heart rate were unchanged. Conclusions: The improvement in AIx and the stability of PWV after SC with NRT indicate improved peripheral vascular tone. This impact may account for the early clinical benefit of SC observed even when associated with NRT.

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Nicotine Patch Therapy in Smoking Cessation Reduces the Extent of Exercise-Induced Myocardial Ischemia

Abstract: Nicotine patches, when used to promote smoking cessation, significantly reduce the extent of exercise-induced myocardial ischemia as assessed by exercise thallium-201 SPECT.

Cited by 113 publications

References 16 publications

Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment

Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment

Smokeless Tobacco and Cardiovascular Risk

Early Improvement in Peripheral Vascular Tone following Smoking Cessation Using Nicotine Replacement Therapy: Aortic Wave Reflection Analysis

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