Nicotine replacement therapy in patients with coronary heart disease - Recommendations for effective use

Cigarette smoking is a very important causative factor in cardiovascular di sease (CVD). Smoking increases the risk of acute myocardial infarction, uns table angina and sudden death, and it is a risk factor for recurrent episod es of these diseases. It is well documented that patients with CVD who stop smoking, decrease their risk of future events markedly. Smoking cessation is obviously very important in this category of patients, and it has been demonstrated in several trials that the use of nicotine re placement therapy (NRT) markedly improves the long term smoking cessation r ates in healthy individuals, with further improvement in the rate if additi onal supportive adjunctive behavioural therapy is offered. The use of NRT products for CVD patients has been, however, sparsely invest igated: only 2 randomised placebo-controlled trials of NRT in these patient s have been published. This fact, and the fact that nicotine has sympathomi metic effects, which lead to increased heart rate, increased blood pressure and coronary vaso-constriction, probably causes doctors to hesitate before using NRT products in this setting. In this paper we review relevant literature on this subject and explore the efficacy and tolerability of NRT in CVD patients, which in this context is limited to patients with ischaemic heart diseases and arrhythmias: Patient s with hypertension, stroke or peripheral vascular diseases are not discuss ed, due to lack of investigations in these fields. We present recommendations for doses and duration of NRT in patients with C VD that, due to the few studies in this field, are mainly based on parallel s from. findings in healthy individuals. The conclusion of the 2 existing r andomised placebo-controlled studies was that nicotine patches are well tol erated by patients with stable angina, and that the use of nicotine patches increases short term smoking cessation rates.