Drugs to Stop Smoking Are Safe for the Heart

MONDAY, December 9, 2013 — Drugs used to help smokers quit are safe for the heart, and one of them cut risk of major heart events in half, according to results from the largest analysis of these medications ever done. The analysis of 63 clinical trials with more than 30,000 smokers found no link between the drugs and heart attacks, strokes, or heart-related deaths.

The results were published in the journal Circulation today; and the research was conducted by a team led by Edward J. Mills, PhD, of Stanford University and the Canada Research Chair at the University of Ottawa.

“Smokers should know that the benefits of stopping smoking dramatically outweigh any concerns of events associated with taking a smoking cessation drug. There is currently no reasonable argument that smoking cessation drugs are associated with important harms,” said Dr. Mills.

Smoking accounts for one of every five deaths, and is now the leading cause of preventable deaths, according to the U.S. Centers for Disease Control and Prevention (CDC), which is why getting smokers to quit is a top public health priority.

In addition to Wellbutrin (bupropion), the stop-smoking treatments used by people in the new analysis were nicotine replacement gum or patches and the nicotine addiction treatment Chantix (varenicline) — all FDA-approved aids to stop smoking. Treatments lasted three months on average, with an additional 12 month follow-up period. The trials that investigators analyzed for drug safety included some of the highest risk patients. Eight trials included smokers with cardiovascular disease and four trials included smokers with chronic obstructive pulmonary disease, COPD. Even for these patients, the smoking cessation aids were not linked to major heart disease.

How Stop-Smoking Aids Protect the Heart

Mills compared the risks with benefits: “Benefits of stopping smoking are nearly immediate and the long-term benefits of stopping smoking include averting serious cardiovascular disease and cancers — both illnesses that can include pain, debilitating quality of life and ultimately, death.”

“While we don’t currently understand the mechanism for why bupropion may decrease the risk of serious cardiovascular disease,” said Mills, “it is likely due to both its effectiveness at stopping smoking — and thus stopping more serious cardiovascular disease.”

“Also, it has antidepressant effects, whereby patients may become more relaxed and this brings down their blood pressure,” he added.

In the short term, smokers who used nicotine replacement as gum or patches had twice the risk of mild heart symptoms that resolved over time. Mills explained, “The short-term effects of nicotine replacement therapy are well known and largely harmless. They include minor issues such as heart palpitations and a rapid pulse.”

Healthcare Providers Helping Smokers Quit

In the United States, about 45 million people smoke cigarettes — nearly 20 percent of all adults, according to the CDC — but their healthcare providers can help them quit. We spoke with cardiologist John D. Day, MD of Intermountain Healthcare in Salt Lake City Utah about how he advises his patients to kick the smoking habit. “I strongly urge all of my patients who are smoking to quit as soon as possible.”

Day explained that every time a patient comes to his clinic, the nurses ask them if they smoke as part of taking their vital signs, while checking them in. If the patient smokes, their chart is flagged for further counseling as part of their office visit.

“I share with them that not only is smoking incredibly hazardous to their heart in that it can cause heart attacks, heart failure, cardiac arrests — but that it also ages them by approximately 10 years.” Day outlines the benefits of quitting for patients, and said, “The good news is that if they can quit before permanent damage is done then the body can repair much of the damage.”

In his practice, Day urges patients to quit with the aid of therapies like nicotine replacement, bupropion, and varenicline. “Whatever it takes for them to give up this toxic habit,” he said. “Whatever potential risks there are from pharmacotherapy, these potential risks can in no way compare to the lethal effects of smoking.”

Day feels it’s fortunate that at Intermountain Healthcare where he works, all of the primary care offices have protocols and trained people in place to assist patients in all aspects of smoking cessation. Day noted, “We provide classes, support groups, counselors as well as trained physicians to help our patients live a better life, free of smoking.”

YOUR VIEWS: Have you tried to stop smoking or succeeded in kicking the habit? Please share your story in the comments box.