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Smoking cessation therapies do not increase risk for serious CVD events
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Three smoking cessation therapies are not associated with an elevated risk for serious CVD events, according to a new meta-analysis.
Edward J. Mills, PhD, MSc, and colleagues analyzed trials that reported CVD outcomes for three smoking cessation therapies: bupropion (Wellbutrin, GlaxoSmithKline), nicotine replacement therapy and varenicline (Chantix, Pfizer). They also accessed internal FDA reports.
The researchers considered two endpoints: all CV events, defined as clinical diagnosis of any CV event considered in previous reviews on risk for CV events linked to smoking cessation therapies; and major adverse CV events, including CV death, nonfatal MI and nonfatal stroke.
There were 63 randomized controlled trials evaluated, covering 30,508 participants.
Mills, of Stanford University School of Medicine, and colleagues found no increase in risk for all-CVD events associated with bupropion (RR=0.98; 95% CI, 0.54-1.73) or varenicline (RR=1.3; 95% CI, 0.79-2.23). They found an elevated risk associated with nicotine replacement therapy (RR=2.29; 95% CI, 1.39-3.82), but it was driven by less serious events. The most commonly reported events associated with nicotine replacement therapy were heart palpitations, the researchers wrote.
Nicotine replacement therapy (RR=1.95; 95% CI, 0.26-4.3) and varenicline (RR=1.34; 95% CI, 0.66-2.66) were not linked to risk for major adverse CV events. Bupropion was associated with a protective effect from major adverse CV events (RR=0.45; 95% CI, 0.21-0.85).
“It is possible that the antidepressant origins of bupropion reduce vascular stress,” the researchers wrote.
Analyzing only patients with previous histories of predisposing conditions for CVD events did not change the results.
“Undoubtedly, the benefits of quitting smoking outweigh any potential risks from smoking cessation therapies,” Mills said in a press release.
The researchers wrote that e-cigarettes were not included in the analysis because they are unregulated and, therefore, there is not much safety data available about them.
Disclosure: Several researchers report financial ties with GlaxoSmithKline, Merck, Novartis, Pfizer and Takeda.
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