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NICOTINE PATCH MINIMALLY EFFECTIVE IN HEART PATIENTS.

Despite the overall safety of transdermal nicotine patches, fear of arrythmias or ischemia may still limit their use in cardiac patients who want to quit smoking. This VA study randomized almost 600 smokers with preexisting cardiac diagnoses to either a nicotine- or placebo-containing patch.

Most patients were men who had smoked more than a pack a day for over 40 years and had tried to quit at least twice. The most common cardiac conditions were angina and myocardial infarction. About a third had undergone angioplasty or bypass surgery. Patients received a standard 10-week tapering-dose supply of patches, and some educational pamphlets on smoking cessation.

The good news: no statistical differences in cardiac outcomes developed between the two groups. Even adverse events such as insomnia and GI distress usually ascribed to transdermal nicotine occurred with comparable frequency.

The bad news: although nicotine recipients were more than twice as likely to have stopped smoking after 14 weeks (21 vs. 9 percent), the difference was no longer significant ten weeks later (14 vs. 11 percent).

Comment: Overall, more than 15 percent of these patients declined in health during the short study period, confirming the urgency of limiting their smoking. Unfortunately, the nicotine patch alone does not appear sufficient for hardcore smokers like these.

— A Zuger

Published in Journal Watch General Medicine December 20, 1996

Citation(s):

Joseph AM et al. The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease. N Engl J Med 1996 Dec 12 335 1792-1798.

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