NEW ORLEANS – Nicotine patches are safe for use in smokers with known coronary artery disease and stress-induced myocardial ischemia, according to the results of the first-ever randomized, placebo-controlled, multicenter clinical trial to examine this issue.
Nicotine therapy doubles the successful smoking quit rate to about 30%, but many physicians have been reluctant to recommend it for their patients with coronary artery disease (CAD) because nicotine is known to increase heart rate and blood pressure and can induce vasoconstriction, Dr. Monika J. Leja reported at the annual scientific session of the American College of Cardiology.
She and her coinvestigators at the Methodist DeBakey Heart Center, Houston, therefore randomized 55 heavy smokers with CAD and a quantified 10% or greater stress-induced myocardial defect by single-photon emission computerized tomography (SPECT) to receive either 21-mg nicotine patches or placebo while continuing to smoke.
The primary end point was change in total perfusion defect size upon repeat stress SPECT imaging at 1 week. There was no change in either the total or ischemic perfusion defect size, compared with baseline in the active- or placebo-patch groups even though plasma nicotine levels in the active-treatment arm jumped from 10.9 to 25.2 ng/mL, Dr. Leja reported.
After 1 week, patients were encouraged to quit smoking while continuing to use their assigned patches.
Upon repeat SPECT imaging at week 4 the size of the perfusion defects in the nicotine patch group remained unchanged from baseline despite the fact that their plasma nicotine levels remained as high as at week 1, lending further support to the safety of nicotine therapy in the CAD population, Dr. Leja said.
The trial was supported by GlaxoSmithKline Consumer Healthcare.
Dr. Leja has no financial relationship to disclose.
Upon repeat SPECT imaging, the size of the perfusion defects in the patch group was unchanged. DR. LEJA