NEW ORLEANS — Nicotine patches are safe for smokers with coronary artery disease and stress-induced myocardial ischemia, according to results of the first randomized, placebo-controlled, multicenter clinical trial to examine this issue.
Nicotine therapy doubles the successful smoking quit rate, but physicians have been reluctant to recommend it to CADpatients because nicotine raises heart rate and blood pressure and can induce vasoconstriction, Dr. Monika J. Leja said at the annual scientific session of the American College of Cardiology.
She and her colleagues at the Methodist DeBakey Heart Center, Houston, randomized 55 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 the total or ischemic perfusion defect size versus baseline in the active- or placebo-patch groups, but plasma nicotine levels in the active-treatment arm rose from 10.9 to 25.2 ng/mL.
At 1 week, patients were told to quit while still using the patches. SPECT imaging at week 4, showed perfusion defect size in the patch group was unchanged despite plasma nicotine levels staying as high as at week 1, supporting nicotine therapy safety in CAD patients. The trial was supported by GlaxoSmithKline Consumer Health-care. Dr. Leja has no financial ties to disclose.
Perfusion defect size in the patch group was static despite a rise in plasma nicotine levels at week 1. DR. LEJA