Transdermal Nicotine Replacement Therapy Safety in Patients with Cardiovascular Disease

Abstract

Purpose The safety and efficacy of nicotine replacement therapy in patients with stable cardiovascular disease and following an acute coronary event are reviewed. Summary Physicians have been hesitant to prescribe nicotine replacement therapy (NRT) in patients with cardiac disease due to the reported harmful cardiovascular effects of nicotine, including an increase in heart rate and blood pressure, as well as its possible contribution to the pathogenesis of coronary artery disease and sudden cardiac death. However, several studies have shown that NRT is safe following myocardial infarction and is preferred over continued cigarette smoking. One cohort study assessed the safety and efficacy of transdermal NRT in smokers admitted for acute coronary syndromes and found no difference in mortality versus patients given a placebo. Additionally, the cost of NRT should not be viewed as a barrier due to the long-term savings in preventable hospitalizations following additional cardiovascular events. Conclusion Transdermal NRT was found to be safe and effective in patients with acute myocardial infarction and with a known history of cardiovascular disease. It has also proven to be effective in smoking cessation, which eliminates the most important risk factor for an acute coronary event. NRT showed no increased frequency in mortality or other cardiac adverse events.