Risk of acute first myocardial infarction and use of nicotine patches in ageneral population

OBJECTIVES To determine if nicotine patches, both as prescribed and used ov er-tile-counter, increase the risk of first myocardial infarction (MI). BACKGROUND Although nicotine patches improve smoking cessation rates, case reports have raised the hypothesis that they may increase the :risk of MI. METHODS A population-based case-control stud) among 68 hospitals in an eigh t-county region surrounding Philadelphia was performed to determine if nico tine patches increase the risk of first MI. Cases were smokers (current or within the prior) ear) admitted to all hospitals in the region with a first MI. Controls were smokers (current or within the prior year) without prior MI selected from the same region using random-digit dialing. Data were col lected by telephone interviews and chart reviews. The study had 80% power C o detect an odds ratio (OR) of 2.5. RESULTS A total of 653 cases and 2,990 controls were interviewed. There was no association between nicotine patches and MI (OR 0.46; 95% CI: 0.09, 1.4 7), and the confidence interval (CI) excluded an effect from nicotine patch es equal to that from cigarette smoking itself(OR < 2.5). Among those who a bstained from smoking, the OF: for use of nicotine patches was 0.25 (95% CI : 0.01, 1.67); among those who smoked concomitantly, the OR for patch use w as 0.83 (95% CI: 0.09, 3.81). Adjustment for confounding did not alter the study's findings (OR adjusted for confounders that could mask a harmful eff ect of patches: 0.70; 95% CI: 0.20, 2.46). CONCLUSIONSNicotine patches, as used in actual practice, do not appear to b e associated with an increased risk of MI. (J Am Coil Cardiol 2001;37:1297- 302) (C) 2001 by the American College of Cardiology.