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November 29, 2021JAMA Network OpenOpen Access

Comparison of Cardiovascular Safety for Smoking Cessation Pharmacotherapies in a Population-Based Cohort in Australia

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Why the study?

To minimize patient risk, prescribers need evidence on how smoking cessation pharmacotherapies compare with one another regarding cardiovascular safety and risk of MACE.

Does varenicline compared to NRT patches or bupropion alter the risk of major adverse cardiovascular events in adults initiating smoking cessation pharmacotherapy?

Population

Adults dispensed prescription smoking cessation pharmacotherapy in New South Wales, Australia

Comparison

Pairwise comparisons of varenicline, NRT patches, and bupropion

Design

Retrospective population-based cohort study

Authors

AHAlys HavardSCStephanie ChoiSPSallie‐Anne Pearson

Discussion

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Overview

May support comparable CV safety across pharmacotherapies; leaves open need for randomized confirmation in high-risk patients.

Structured PICO

Does varenicline compared to NRT patches or bupropion alter the risk of major adverse cardiovascular events in adults initiating smoking cessation pharmacotherapy?

P
Population
Adults in New South Wales, Australia, dispensed a prescription smoking cessation pharmacotherapy (varenicline, NRT patches, or bupropion) between 2008 and 2015 or between 2011 and 2015. Mean age ranged from 41.9 to 49.8 years, and the proportion of women ranged from 42.8% to 52.2%.
I
Intervention
Varenicline (first course of smoking cessation pharmacotherapy)
C
Comparator
Nicotine replacement therapy (NRT) patches or bupropion (first course of smoking cessation pharmacotherapy)
O
Outcome
Major adverse cardiovascular events (MACE), defined as a composite of acute coronary syndrome, stroke, and cardiovascular deathcomposite

Varenicline and NRT patches have a similar risk of major adverse cardiovascular events, supporting the cardiovascular safety of varenicline as a first-line smoking cessation therapy.

Limitations

  • Inconclusive results for comparisons involving bupropion owing to wide confidence intervals

Cite This Study

Havard et al. (2021) studied this question.

synapsesocial.com/papers/6a7152e08031ec7bb1dce4b3https://doi.org/10.1001/jamanetworkopen.2021.36372
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The use of propensity score methods with survival or time‐to‐event outcomes: reporting measures of effect similar to those used in randomized experiments2013 · 1,463 citations
  2. 2Efficacy and Safety of Varenicline for Smoking Cessation in Patients With Cardiovascular Disease2010 · 374 citations
  3. 3Bupropion SR for smoking cessation in smokers with cardiovascular disease: a multicentre, randomised study2003 · 246 citations
  4. 4Cardiovascular Events Associated With Smoking Cessation Pharmacotherapies2013 · 410 citations
  5. 5Quality of Diagnosis and Procedure Coding in ICD-10 Administrative Data2006 · 411 citations