Smoking cessation: lessons learned from clinical trial evidence.
OBJECTIVE
Cigarette smoking and exposure to secondhand smoke cause coronary heart disease. Cessation dramatically reduces the incidence of primary and secondary cardiac events. The review presents up-to-date information regarding nicotine dependence, recent findings related to its treatment, and recommendations for addressing smoking cessation for the primary and secondary prevention of coronary heart disease.


RESULTS
Bans on smoking in public places are associated with significant reductions in the incidence of acute myocardial infarction. Counseling and pharmacotherapy (nicotine replacement therapy, bupropion) are proven, effective treatments for nicotine dependence. Clinical trials of two new pharmacotherapies, varenicline and rimonabant, have recently been reported. Varenicline is a safe and efficacious medication for smoking cessation, and has been approved in the US, Canada and Europe. Rimonabant has shown mixed results for smoking cessation and is undergoing further evaluation.


CONCLUSIONS
All patients should be screened for tobacco use. Clinicians can effectively treat nicotine dependence in the general population using counseling and first-line pharmacotherapies (nicotine replacement therapy, bupropion, varenicline). These same treatments, with some modification, are appropriate for smokers with coronary heart disease; however, brief interventions without follow-up are not effective in this population. For smokers with coronary heart disease, the best time to intervene may be during hospitalization.
Reid
Robert D
RD
Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Canada. breid@ottawaheart.ca
Quinlan
Bonnie
B
Riley
Dana L
DL
Pipe
Andrew L
AL
D001552:Benzazepines / Q000494:pharmacology; D016642:Bupropion / Q000494:pharmacology; D002318:Cardiovascular Diseases / Q000209:etiology; D002986:Clinical Trials as Topic; D018765:Dopamine Uptake Inhibitors / Q000494:pharmacology; D006801:Humans; D018722:Nicotinic Agonists / Q000494:pharmacology*; D010880:Piperidines / Q000494:pharmacology; D011720:Pyrazoles / Q000494:pharmacology; D011810:Quinoxalines / Q000494:pharmacology; D000077285:Rimonabant; D012907:Smoking / Q000009:adverse effects / Q000188:drug therapy*; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D000068580:Varenicline
D001552:Benzazepines; D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D010880:Piperidines; D011720:Pyrazoles; D011810:Quinoxalines; D016642:Bupropion; D000077285:Rimonabant; D000068580:Varenicline