Prevention and Treatment of Tobacco Use

Q: What is the clinical evidence from this study?

Study design: Review. Population: Tobacco use and cardiovascular disease. Intervention: Tobacco cessation pharmacotherapy (varenicline, bupropion, nicotine replacement therapy), behavioral support, and tobacco control policies. Primary outcome: Smoking abstinence and reduction of smoking-related cardiovascular disease.

Sara Kalkhoran; Neal L. Benowitz; Nancy A. Rigotti

doi:10.1016/j.jacc.2018.06.036

August 1, 2018Journal of the American College of CardiologyOpen Access

Prevention and Treatment of Tobacco Use

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Key result

First-line smoking cessation pharmacotherapy combined with behavioral support safely improves abstinence in cardiovascular disease.

Why the study?

Do tobacco cessation pharmacotherapies, behavioral support, and public health policies safely and effectively reduce tobacco use and cardiovascular risk in patients with or at risk for cardiovascular disease?

Key Points

To review the epidemiology and cardiovascular risks of tobacco use, and evaluate clinical and policy strategies for tobacco prevention and cessation.
Narrative clinical review synthesizing epidemiological data on combustible cigarettes, e-cigarettes, and smokeless tobacco.
Evaluation of evidence-based cessation strategies, including first-line pharmacotherapies and behavioral interventions, in individuals with cardiovascular disease (CVD).
Assessment of public health tobacco control policies, including taxation, smoke-free legislation, and marketing restrictions.
Current cigarette smoking significantly increases the odds of myocardial infarction (OR 2.87, 95% CI 2.58–3.19) and doubles stroke mortality compared to never smoking.
Persistent smoking following coronary artery bypass graft surgery increases all-cause mortality (RR 1.68, 95% CI 1.33–2.13), while continued smoking after percutaneous revascularization increases death (RR 1.76, 95% CI 1.37–2.26) and Q-wave myocardial infarction (RR 2.08, 95% CI 1.16–3.72).
First-line medications (varenicline, bupropion, and nicotine replacement) are safe and effective in CVD, showing maximum efficacy when paired with behavioral counseling.

Structured PICO

Do tobacco cessation pharmacotherapies, behavioral support, and public health policies safely and effectively reduce tobacco use and cardiovascular risk in patients with or at risk for cardiovascular disease?

P

Population

Youth, adult smokers, and patients with or at risk for cardiovascular disease.

I

Intervention

Tobacco cessation treatments including first-line pharmacotherapy (varenicline, bupropion, nicotine replacement therapy), behavioral counseling, and public health tobacco control policies

O

Outcome

Smoking cessation (abstinence) and reduction of smoking-related cardiovascular morbidity and mortalityhard clinical

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Implication

This comprehensive review highlights that treating tobacco use with combined behavioral support and pharmacotherapy (varenicline, bupropion, or nicotine replacement) is safe, effective, and should be prioritized alongside managing other major cardiovascular risk factors.

Abstract

Tobacco use is the leading preventable cause of death worldwide and a major risk factor for cardiovascular disease (CVD). Both prevention of smoking initiation among youth and smoking cessation among established smokers are key for reducing smoking prevalence and the associated negative health consequences. Proven tobacco cessation treatment includes pharmacotherapy and behavioral support, which are most effective when provided together. First-line medications (varenicline, bupropion, and nicotine replacement) are effective and safe for patients with CVD. Clinicians who care for patients with CVD should give as high a priority to treating tobacco use as to managing other CVD risk factors. Broader tobacco control efforts to raise tobacco taxes, adopt smoke-free laws, conduct mass media campaigns, and restrict tobacco marketing enhance clinicians’ actions working with individual smokers.

Discussion

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Cite This Study

Kalkhoran et al. (2018) conducted a review in Tobacco use and cardiovascular disease. Tobacco cessation pharmacotherapy (varenicline, bupropion, nicotine replacement therapy), behavioral support, and tobacco control policies was evaluated on Smoking abstinence and reduction of smoking-related cardiovascular disease. First-line smoking cessation medications (varenicline, bupropion, and nicotine replacement) combined with behavioral support are effective and safe for patients with cardiovascular disease.

synapsesocial.com/papers/6a5ee5215ca62919990675fe https://doi.org/10.1016/j.jacc.2018.06.036

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Prevention and Treatment of Tobacco Use

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prevention and Treatment of Tobacco Use

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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