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Nicotine Patch Is Safe for Cardiac Patients (But Does It Work?)

Transdermal nicotine can aid smoking cessation and is now available over the counter. Many physicians avoid recommending nicotine patches to patients with cardiac disease because of reports of myocardial infarction and stroke associated with the patches. This randomized trial investigated the safety and efficacy of transdermal nicotine in 584 smokers with at least one cardiovascular disease.

Patients in 10 veterans' medical centers received either nicotine or placebo patches for 10 weeks and were followed for cardiovascular endpoints for a total of 14 weeks. The occurrence of minor cardiovascular endpoints (peripheral vascular disease or stroke) and major endpoints (death or MI) was high in both groups (16%). Side effects did not differ significantly between the groups. After 14 weeks, the nicotine group had a higher rate of smoking abstinence than the placebo group (21% vs. 9%), but by 24 weeks the difference was nonsignificant (14% vs. 11%).

Comment: This study included only eight women, but tobacco use is a major cause of morbidity and mortality in both sexes. The nicotine patch appears safe for patients with cardiac disease but is not more effective than placebo for smoking cessation. Large-scale trials are needed to evaluate aids to smoking cessation in female smokers.

— SD Gharib

Published in Journal Watch Women's Health February 1, 1997

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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