Smoking cessation in patients with coronary artery disease.
BACKGROUND
Smoking cessation is an important factor in the primary and secondary prevention of cardiac events. Although multiple clinical trials have examined the efficacy of various smoking cessation aids, a systematic review of the efficacy and safety of smoking cessation aids has not been done.


METHODS
This paper reviews the effects of smoking on coronary artery disease. In addition, we identify randomized controlled trials examining the efficacy and safety of smoking cessation aids from the years 1970 to 2004. We then pooled the trial results for 6- and 12-month rates of continuous smoking abstinence.


RESULTS
The 4 principal mechanisms of cardiovascular damage caused by cigarette smoking are induction of a hypercoagulable state, reduction of oxygen delivery because of carbon monoxide, coronary vasoconstriction, and nicotine-induced hemodynamic effects. Our review of clinical trials suggests that each smoking cessation aid improved continuous smoking abstinence rates at both 6 and 12 months compared with placebo. The 12-month abstinence rates for the active versus placebo treatments were the following: nicotine patch 11.1% versus 5.5%, nicotine gum 27.3% versus 16.5%, nicotine inhaler 16.9% versus 9.1%, bupropion 18.5% versus 6.6%, and behavioral therapy 20.0% versus 13.9%.


CONCLUSIONS
Several smoking-related mechanisms are responsible for the development of atherosclerosis and the induction of cardiac events. Smoking cessation aids effect a modest increase in smoking abstinence at 12 months compared with placebo. In spite the apparent success of cessation aids, smoking relapse rates are quite high.
Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Jason
J
Ludvig
Brienne
B
Miner
Mark J
MJ
Eisenberg
D000279:Administration, Cutaneous; D000280:Administration, Inhalation; D000284:Administration, Oral; D050197:Atherosclerosis / Q000517:prevention & control; D001521:Behavior Therapy; D016642:Bupropion / Q000627:therapeutic use; D002248:Carbon Monoxide / Q000097:blood; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D004311:Double-Blind Method; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data; D013375:Substance Withdrawal Syndrome / Q000150:complications; D019851:Thrombophilia / Q000209:etiology / Q000517:prevention & control; D014029:Tobacco Use Disorder / Q000150:complications / Q000628:therapy; D014661:Vasoconstriction / Q000187:drug effects
D016642:Bupropion; D009538:Nicotine; D002248:Carbon Monoxide