Cardiovascular effects of pharmacologic therapies for smoking cessation

Abstract

Tobacco dependence is a potent risk factor for cardiovascular (CV) diseases and despite known harms of smoking and benefits associated with smoking cessation, approximately 20% of the adult population with CV diseases or hypertension continue to smoke. Extensive research has demonstrated that nicotine replacement, varenicline, and bupropion sustained-release are superior to placebo for short- and intermediate-term smoking cessation. Due to their mechanisms of action, some smoking cessation therapies have been thought to have the potential to increase CV risk, particularly if the pharmacotherapies are taken while individuals are still smoking. Hence, we have analytically reviewed the literature describing the CV effects of therapies for smoking cessation, particularly as they apply to patients with CV disease.

Varenicline and Cytisine Diminish the Dysphoric-Like State Associated with Spontaneous Nicotine Withdrawal in Rats

“…Cytisine might also be given additional consideration as smoking cessation aid because cytisine has a lower sensitivity than varenicline for human a3b4* nAChRs (ganglionic receptor) (Stokes and Papke, 2012). The a3b4* nAChR is highly expressed in brain stem areas involved in cardiovascular control and stimulation of these receptors may increase the risk for cardiovascular disorders (Sobieraj et al, 2013;Perry et al, 2002).…”

South African tobacco smoking cessation clinical practice guideline

“…[29,34] Recent studies have also reported that varenicline appears to be safe in patients with schizophrenia [35] and in patients with cardiac disease. [29,[36][37][38] Nevertheless, it should be used with caution and under supervision. Champix is a schedule 5 drug in SA and patients should be monitored regularly with particular attention to changes in their emotional state, unusual behaviour and suicidal ideation.…”

Smoking Cessation in Long-Term Conditions: Is There “An Opportunity in Every Difficulty”?

“…Another barrier is the concern about safety of NRT, bupropion, and varenicline in patients with cardiovascular conditions due to their possible hemodynamic effects [106,107]. Whilst such concerns may be justified on the basis of pharmacodynamics profiles, clinical studies have found no evidence of increased risk of cardiovascular events associated with these treatments [106].…”

“…Whilst such concerns may be justified on the basis of pharmacodynamics profiles, clinical studies have found no evidence of increased risk of cardiovascular events associated with these treatments [106]. Studies to-date have been relatively small and may, therefore, have missed potential adverse effects; there is a general consensus that the benefits of cessation interventions outweigh the risks of any potential, yet unsubstantiated, safety concerns.…”