What question did this study set out to answer?

To evaluate the cardiovascular toxicity of nicotine alone compared to tobacco smoke and assess the cardiovascular safety of nicotine replacement therapies.

May 13, 2026Journal of the American College of Cardiology

Cardiovascular Toxicity of Nicotine: Implications for Nicotine Replacement Therapy 11All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California San Francisco.

Q: What is the clinical evidence from this study?

Study design: Review. Population: Smoking and cardiovascular disease. Intervention: Nicotine replacement therapy vs. Cigarette smoking. Primary outcome: Cardiovascular risk.

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Key result

Nicotine replacement therapy does not increase cardiovascular risk in stable coronary disease.

Why the study?

Information regarding the cardiovascular safety of nicotine replacement therapy in smokers, including those with cardiovascular disease, is not readily available to most physicians.

Does nicotine replacement therapy increase cardiovascular risk in smokers with underlying cardiovascular disease compared to cigarette smoking?

Population

Smokers including those with underlying stable coronary disease

Comparison

Nicotine replacement therapy vs cigarette smoking

Design

Review article

Authors

NBN BENOWITZCentre for Addiction and Mental Health SGSteven G GourlaySan Francisco General Hospital

Discussion

Member takes

Implication

Nicotine replacement therapy is considered safe for smokers with stable coronary disease, as the minimal cardiovascular risks are substantially outweighed by the benefits of smoking cessation.

Key Points

To evaluate the cardiovascular toxicity of nicotine alone compared to tobacco smoke and assess the cardiovascular safety of nicotine replacement therapies.
Reviewed physiological and pharmacological data examining hemodynamic responses, sympathetic stimulation, catecholamine release, and blood coagulability.
Assessed outcomes from clinical trials of transdermal nicotine and nicotine gum, particularly among individuals with preexisting, stable coronary heart disease.
Nicotine replacement therapy delivers nicotine more slowly and at lower doses than combustible cigarettes, lacking the combustion products that induce blood hypercoagulability.
Clinical trials in patients with stable coronary disease indicate nicotine replacement therapy does not increase acute cardiovascular event risk, and smoking while using NRT presents risks no greater than smoking alone.
The cardiovascular risks of nicotine replacement therapy remain minimal and are substantially outweighed by the health benefits achieved through smoking cessation.

Structured PICO

Does nicotine replacement therapy increase cardiovascular risk in smokers with underlying cardiovascular disease compared to cigarette smoking?

Population

Smokers, including those with underlying stable coronary disease

Intervention

Nicotine replacement therapy (NRT), including nicotine gum and transdermal patches

Comparator

Cigarette smoking

Outcome

Cardiovascular risk and acute cardiovascular eventssafety

Nicotine replacement therapy is considered safe for smokers with stable coronary disease, as the minimal cardiovascular risks are substantially outweighed by the benefits of smoking cessation.

Cite This Study

BENOWITZ et al. (1997) conducted a review in Smoking and cardiovascular disease. Nicotine replacement therapy vs. Cigarette smoking was evaluated on Cardiovascular risk. Nicotine replacement therapy does not increase cardiovascular risk in patients with stable coronary disease, and its small risks are substantially outweighed by the benefits of smoking cessation.

synapsesocial.com/papers/6a0441fd151c485067848be3 https://doi.org/10.1016/s0735-1097(97)00079-x

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Implication

Nicotine replacement therapy is considered safe for smokers with stable coronary disease, as the minimal cardiovascular risks are substantially outweighed by the benefits of smoking cessation.

Cardiovascular Toxicity of Nicotine: Implications for Nicotine Replacement Therapy 11All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California San Francisco.

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Cardiovascular Toxicity of Nicotine: Implications for Nicotine Replacement Therapy 11All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California San Francisco.

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider