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Nicotine Replacement Therapy in Patients with Coronary Heart Disease

Recommendations for Effective Use

  • Disease Management
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Abstract

Cigarette smoking is a very important causative factor in cardiovascular disease (CVD). Smoking increases the risk of acute myocardial infarction, unstable angina and sudden death, and it is a risk factor for recurrent episodes of these diseases. It is well documented that patients with CVD who stop smoking, decrease their risk of future events markedly.

Smoking cessation is obviously very important in this category of patients, and it has been demonstrated in several trials that the use of nicotine replacement therapy (NRT) markedly improves the long term smoking cessation rates in healthy individuals, with further improvement in the rate if additional supportive adjunctive behavioural therapy is offered.

The use of NRT products for CVD patients has been, however, sparsely investigated: only 2 randomised placebo-controlled trials of NRT in these patients have been published. This fact, and the fact that nicotine has sympathomimetic effects, which lead to increased heart rate, increased blood pressure and coronary vasoconstriction, probably causes doctors to hesitate before using NRT products in this setting.

In this paper we review relevant literature on this subject and explore the efficacy and tolerability of NRT in CVD patients, which in this context is limited to patients with ischaemic heart diseases and arrhythmias. Patients with hypertension, stroke or peripheral vascular diseases are not discussed, due to lack of investigations in these fields.

We present recommendations for doses and duration of NRT in patients with CVD that, due to the few studies in this field, are mainly based on parallels from findings in healthy individuals. The conclusion of the 2 existing randomised placebo-controlled studies was that nicotine patches are well tolerated by patients with stable angina, and that the use of nicotine patches increases short term smoking cessation rates.

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Authors and Affiliations

  1. Gentofte University Hospital, Niels Andersensvej, Hellerup, Denmark

    Charlotta Pisinger, Poul Wennike &  Philip Tønnesen

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  1. Charlotta Pisinger
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  2. Poul Wennike
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  3. Philip Tønnesen
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Correspondence to Philip Tønnesen.

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Pisinger, C., Wennike, P. & Tønnesen, P. Nicotine Replacement Therapy in Patients with Coronary Heart Disease. Mol Diag Ther 12, 99–110 (1999). https://doi.org/10.2165/00023210-199912020-00003

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