title: Efficacy and Safety of Smoking Cessation Interventions in Patients With Cardiovascular Disease: A Network Meta-Analysis of Randomized Controlled Trials.
abstract: Although the efficacy and safety of smoking cessation interventions are well established, their efficacy and safety in patients with cardiovascular disease (CVD) remain unclear. The objective of this study was to evaluate the efficacy and safety of pharmacological and behavioral smoking cessation interventions in CVD patients via a meta-analysis of randomized controlled trials.
  
  
  
  EMBASE, PsycINFO, MEDLINE, PubMed, and the Cochrane Tobacco Addiction Specialized Register were searched for randomized controlled trials evaluating the efficacy of smoking cessation pharmacotherapies and behavioral therapies in CVD patients. Outcomes of interest were smoking abstinence at 6 and 12 months, defined using the most rigorous criteria reported. Data were pooled across studies for direct comparisons using random-effects models. Network meta-analysis using a graph-theoretical approach was used to generate the indirect comparisons. Seven pharmacotherapy randomized controlled trials (n=2809) and 17 behavioral intervention randomized controlled trials (n=4666) met our inclusion criteria. Our network meta-analysis revealed that varenicline (relative risk [RR]: 2.64; 95% confidence interval [CI], 1.34-5.21) and bupropion (RR: 1.42; 95% CI, 1.01-2.01) were associated with greater abstinence than placebo. The evidence about nicotine replacement therapies was inconclusive (RR: 1.22; 95% CI, 0.72-2.06). Telephone therapy (RR: 1.47; 95% CI: 1.15-1.88) and individual counseling (RR: 1.64, 95% CI: 1.17-2.28) were both more efficacious than usual care, whereas in-hospital behavioral interventions were not (RR: 1.05; 95% CI, 0.78-1.43).
  
  
  
  Our meta-analysis suggests varenicline and bupropion, as well as individual and telephone counseling, are efficacious for smoking cessation in CVD patients.
authors.affiliation: From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada (K.S., J.L., M.J.E., M.E., P.M.R., K.B.F.).
authors.forename: Karine
authors.initials: K
authors.lastname: Suissa
authors.affiliation: From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada (K.S., J.L., M.J.E., M.E., P.M.R., K.B.F.).
authors.forename: Jordan
authors.initials: J
authors.lastname: Larivière
authors.affiliation: From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada (K.S., J.L., M.J.E., M.E., P.M.R., K.B.F.).
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
authors.affiliation: From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada (K.S., J.L., M.J.E., M.E., P.M.R., K.B.F.).
authors.forename: Maria
authors.initials: M
authors.lastname: Eberg
authors.affiliation: From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada (K.S., J.L., M.J.E., M.E., P.M.R., K.B.F.).
authors.forename: Genevieve C
authors.initials: GC
authors.lastname: Gore
authors.affiliation: From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada (K.S., J.L., M.J.E., M.E., P.M.R., K.B.F.).
authors.forename: Roland
authors.initials: R
authors.lastname: Grad
authors.affiliation: From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada (K.S., J.L., M.J.E., M.E., P.M.R., K.B.F.).
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.affiliation: From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada (K.S., J.L., M.J.E., M.E., P.M.R., K.B.F.).
authors.forename: Pauline M
authors.initials: PM
authors.lastname: Reynier
authors.affiliation: From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada (K.S., J.L., M.J.E., M.E., P.M.R., K.B.F.). kristian.filion@mcgill.ca.
authors.forename: Kristian B
authors.initials: KB
authors.lastname: Filion
mesh_terms: D016642:Bupropion / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003376:Counseling; D006801:Humans; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013997:Time Factors; D000068580:Varenicline / Q000627:therapeutic use*
chemical_list: D018722:Nicotinic Agonists; D016642:Bupropion; D000068580:Varenicline
keywords: behavior therapy; bupropion; cardiovascular disease; meta-analysis; smoking; tobacco use cessation products; varenicline