title: Cardiovascular events associated with smoking cessation pharmacotherapies: a network meta-analysis.
abstract: BACKGROUND
  Stopping smoking is associated with many important improvements in health and quality of life. The use of cessation medications is recommended to increase the likelihood of quitting. However, there is historical and renewed concern that smoking cessation therapies may increase the risk of cardiovascular disease events associated within the quitting period. We aimed to examine whether the 3 licensed smoking cessation therapies-nicotine replacement therapy, bupropion, and varenicline-were associated with an increased risk of cardiovascular disease events using a network meta-analysis.
  
  
  RESULTS
  We searched 10 electronic databases, were in communication with authors of published randomized, clinical trials (RCTs), and accessed internal US Food and Drug Administration reports. We included any RCT of the 3 treatments that reported cardiovascular disease outcomes. Among 63 eligible RCTs involving 21 nicotine replacement therapy RCTs, 28 bupropion RCTs, and 18 varenicline RCTs, we found no increase in the risk of all cardiovascular disease events with bupropion (relative risk [RR], 0.98; 95% confidence interval [CI], 0.54-1.73) or varenicline (RR, 1.30; 95% CI, 0.79-2.23). There was an elevated risk associated with nicotine replacement therapy that was driven predominantly by less serious events (RR, 2.29; 95% CI, 1.39-3.82). When we examined major adverse cardiovascular events, we found a protective effect with bupropion (RR, 0.45; 95% CI, 0.21-0.85) and no clear evidence of harm with varenicline (RR, 1.34; 95% CI, 0.66-2.66) or nicotine replacement therapy (RR, 1.95; 95% CI, 0.26-4.30).
  
  
  CONCLUSIONS
  Smoking cessation therapies do not appear to raise the risk of serious cardiovascular disease events.
authors: Stanford Prevention Research Center, Stanford University, Stanford, CA (E.J.M., K.T., J.J.P.); Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada (E.J.M., S.E., P.W.); and Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada (K.T.).
authors: Edward J
authors: EJ
authors: Mills
authors: Kristian
authors: K
authors: Thorlund
authors: Shawn
authors: S
authors: Eapen
authors: Ping
authors: P
authors: Wu
authors: Judith J
authors: JJ
authors: Prochaska
mesh_terms: D000328:Adult; D001552:Benzazepines / Q000008:administration & dosage / Q000009:adverse effects; D016642:Bupropion / Q000008:administration & dosage / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D011810:Quinoxalines / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D012907:Smoking / Q000188:drug therapy* / Q000453:epidemiology*; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data*; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D011810:Quinoxalines; D016642:Bupropion; D009538:Nicotine; D000068580:Varenicline
keywords: bupropion; cardiovascular diseases; meta-analysis; smoking cessation; tobacco use cessation products; varenicline