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Majority of Chantix users return to smoking after cardiac event
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More than half of patients who received Chantix after an acute coronary syndrome event resumed smoking, according to findings recently published in the Canadian Medical Association Journal.
“Varenicline ... has been widely studied in the general population, with efficacy appearing to meet or exceed that of nicotine replacement therapies and bupropion,” Sarah B. Windle, MPH, of the Jewish General Hospital, McGill University in Montreal, and colleagues wrote. “Along with bupropion, varenicline has been shown to increase abstinence in patients with stable cardiovascular disease; however, its efficacy in patients with acute coronary syndrome was previously unknown.”
Researchers randomly assigned 302 patients with acute coronary syndrome in a 1:1 ratio to receive either Chantix (varenicline, Pfizer) or placebo for 12 weeks. All participants received low-intensity counseling and were told to stop smoking upon discharge from the hospital for their acute coronary syndrome event.
Researchers found that 1 year after the acute coronary event, only 34.4% of participants had stopped smoking. Point estimates suggest that vs. placebo, varenicline use lowered daily cigarette smoking by 50% or more (57.8% vs. 49.7%; 95% CI, –3.1 to 19.4); increased continuous abstinence (31.1% vs. 21.2%; 95% CI, –0.01 to 19.8); and increased point-prevalence abstinence (39.9% vs. 29.1%; 95% CI; 0.01-21.44). Rates of serious adverse events and major adverse cardiovascular events were comparable between the two groups of patients.
Windle and colleagues wrote that participants in this study took titrated levels of varenicline over 7 days since they had already stopped smoking due to the hospital’s admission policy. Researchers added use in this study was different than the usual prescribing pattern of varenicline, which is that patients begin taking it 8 to 14 days before a quit date to allow time for bioaccumulation and titration.
“This approach appears to have been efficacious ... [but] could have resulted in increased ‘slips’ (i.e., temporary lapses to smoking) early in the trial, limiting our ability to detect significant differences between groups in regard to continuous smoking abstinence,” they added.
“If varenicline were used routinely after acute coronary syndrome, for every 10 smokers who received treatment there would be one less smoker a year later,” Windle and colleagues concluded.
In a related editorial, Robert D. Reid PhD, of the divisions of prevention and rehabilitation and of cardiology, at the University of Ottawa Heart Institute, wrote that Windle and colleagues findings, combined with other research on varenicline, drive home the point that smokers usually need several tools to help them quit.
“Given the powerful effect of smoking cessation on subsequent cardiovascular morbidity and mortality, smoking cessation interventions including counselling and medications, initiated in the hospital and integrated into postdischarge support, should be standard practice for patients with acute coronary syndrome receiving treatment at hospitals... Anything less reflects substandard care.” – by Janel Miller
Disclosure: Windle reports no relevant financial disclosures. Reid reports receiving speaking fees from Johnson & Johnson, which manufactures smoking cessation therapies and speaking fees and a research grant from Pfizer, the maker of varenicline. Please see the study for all other authors’ relevant financial disclosures.