Do Smoking Cessation Therapies Raise CVD Risk?

There is no evidence that smoking cessation pharmacotherapies are associated with an increased risk of cardiovascular adverse events during or after treatment, according to the results of a recent study.

Concerns of the cardiovascular safety of smoking cessation pharmacotherapies—including varenicline, bupropion, and nicotine replacement therapy—have been raised in the past.

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For the current study, the researchers conducted a randomized, double-blind, triple-dummy, placebo- and active-controlled clinical trial (Evaluating Adverse Events in a Global Smoking Cessation Study [EAGLES]) involving 8058 smokers who received at least 1 dose of study medication and a subset of those who completed 12 weeks of treatment plus 12 weeks of ollow up who were followed for an additional 28 weeks (n = 4595). Study medications included varenicline, 1 mg twice daily; bupropion hydrochloride, 150 mg twice daily; and nicotine replacement therapy, 21-mg/d patch with tapering.

Time to the development of a major adverse cardiovascular event (MACE) was the study’s primary endpoint, while development of MACE and other pertinent cardiovascular events (MACE+) served as the secondary endpoint.

Overall, the incidence of cardiovascular events during treatment and follow-up was  <0.5% for MACE and <0.8% for MACE+ and did not significantly differ by treatment. Nor were there any significant treatment differences in time to cardiovascular events.

“The findings of EAGLES and its extension trial provide further evidence that smoking cessation medications do not increase the risk of serious cardiovascular events in the general population of smokers.”

—Michael Potts

Reference:

Benowitz NL, Pipe A, West R, et al. Cardiovascular safety of varenicline, bupropion, and nicotine patch in smokers. JAMA Intern Med. 2018;178(5):622-631.