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WHAT IS THE BACKGROUND?

Some previous studies raised concerns that smoking cessation therapies might increase the risk of cardiovascular disease events.

WHAT WAS THE METHOD?

A meta-analysis of 21 randomised controlled trials assessing nicotine replacement therapy (NRT), bupropion (28) and varenicline (18).

WHAT WERE THE RESULTS?

Neither bupropion nor varenicline increased the risk of CVD events but NRT more than doubled (odds ratio 2.29) the risk. However, these were predominantly less serious events, such as tachycardia, which the authors comment is “a well-known and largely benign effect of NRT”. No evidence of an increased CVD risk emerged with any pharmacotherapy in patients at higher risk based on a history of predisposing conditions – albeit based on a smaller sample. Indeed bupropion reduced the risk of major adverse cardiovascular events, such as cardiovascular death, myocardial infarction and stroke, by 55 per cent. Neither varenicline nor NRT significantly influenced this risk.

WHAT WAS THE CONCLUSION?

Smoking cessation pharmacotherapies do not appear to increase the risk of serious CVD events.

REFERENCE

Mills EJ, Thorlund K, Eapen S, Wu P, Prochaska JJ (2014). Cardiovascular events associated with smoking cessation pharmacotherapies: a network meta-analysis. Circulation Jan 7; 129(1):28-41