Smoking Cessation Therapies Do Not Raise Cardiovascular Risk
Despite the proven efficacy of smoking cessation medications, some doctors hesitate to prescribe them because of suspected side effects such as heart attack and stroke.
A new, large-scale study led by UC San Francisco may help allay these concerns. It found that these therapies do not increase the risk of serious cardiovascular events during or after treatment, further supporting their use in helping smokers break the habit and reduce disease and early death.
This study finds that in the general population of smokers, the benefit of improved cardiovascular health from pharmacotherapy-assisted smoking cessation exceeds any risk of medication-induced cardiovascular harm. said lead author Neal Benowitz, MD, professor of medicine and chief of clinical pharmacology at UCSF.
The study was published online April 9 in JAMA Internal Medicine.
Cigarette smoking is associated with a greater risk of heart attack, stroke, vascular disease, atrial fibrillation, sudden death and worsening heart failure, and according to the CDC, nearly seven out of 10 smokers reported a desire to quit.
National guidelines recommend smoking cessation pharmacotherapy for smokers trying to quit, with options including the drugs varenicline, bupropion or the nicotine replacement therapy patch. A review by the US Department of Health and Human Services found that using one of these methods approximately doubles the likelihood of a smokers long-term abstinence from tobacco compared with placebo.
Trying To Quit Smoking Heres What You Should Know About The Nicotine Patch
- Trying to Quit Smoking? Heres What You Should Know about the Nicotine Patch
Nicotine. Weve all heard this word in relation to tobacco use, but did you know that nicotine is even more powerful than morphine? Learn more about how to safely use nicotine in a positive way to give up cigarettes, which has many benefits for your health. Patricia Mallaber, M.S., R.N., A.N.P.-B.C., C.T.T.S., nurse practitioner with Wilmot Cancer Institutes Tobacco Dependence Treatment program, answers some common questions about nicotine.
What is nicotine?
Nicotine is a chemical thats found in the tobacco plant itself. Its what makes smoking cigarettes and using other tobacco products addictive. While other chemicals in the cigarette are carcinogenic, nicotine in and of itself is not what puts you at risk of health problems like cancer. Its just what keeps you going back to light up despite knowing the harms of continuing to smoke.
What should I know about using the nicotine patch?
Nicotine patches come in three different doses. Dosage should be chosen based on how much you currently smoke. Check package instructions regarding appropriate dosing or ask your health care provider about what dose is appropriate for you. If you experience dizziness, rapid heartbeat or nausea, this may mean you are getting too much nicotine and you may need to reduce the nicotine patch dose.
When should I use the nicotine patch?
Where on my body should I put the nicotine patch?
Can I smoke with the patch on?
Can You Wear 2 Nicotine Patches At Once
3. MYTH: Using more than one NRT product at a time, or at the same time as an e-cigarette is dangerous. THE FACTS: No, it isnt. In fact, using more than one NRT product at a time known as combination therapy can be a good thing as it often increases your chances of success.
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What Should I Tell My Health Care Provider Before I Take This Medicine
They need to know if you have any of these conditions:
- heart disease, angina, irregular heartbeat or previous heart attack
- high blood pressure
- seizures or history of seizures
- stomach problems or ulcers
- an unusual or allergic reaction to nicotine, other medicines, foods, dyes, or preservatives
- pregnant or trying to get pregnant
Chronic Cardiovascular Effects Of Nicotine
An increased rate of development of aortic and carotid atherosclerosis during nicotine treatment of cholesterol-fed rabbits has been observed. Although these two studies suggest that nicotine may be atherogenic in the presence of hypercholesterolemia, the plasma concentrations of cholesterol produced were several fold greater than those usually seen in hypercholesterolemic humans. Another study used a lower dose of nicotine and a 2% cholesterol diet and failed to demonstrate increased atherosclerosis.
Oral nicotine administered to rats to achieve blood levels comparable to those in human smokers produced greater myointimal thickening of the aorta after experimental injury than that in control animals. The excessive myointimal thickening in nicotine treated animals is consistent with a response to persistent injury to endothelial cells.
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Effects Of Smoking On Your Cardiovascular System
Cigarette smoking is a major preventable cause of premature cardiovascular disease, with the risk particularly high in people with hypertension. Cigarette smoking increases the likelihood of having a heart attack or stroke because it adds to the damage done to the blood vessels by high blood pressure and high cholesterol levels.
Chronic smoking also stiffens the arteries making them less flexible as blood passes through them. As a result the heart has to work harder to move blood through the body in cigarette smokers.
Nicotine, the addictive chemical found in combustible cigarettes and other tobacco products, has been found to acutely increase blood pressure through its effects on the sympathetic nervous system. Therefore all people, especially those who already have hypertension, should quit smoking as soon as possible.
Many people, including cigarette smokers, are unaware that they have high blood pressure because the symptoms are nonspecific and therefore can be attributed to many other medical conditions.
High Blood Pressure Symptoms
- Sexual dysfunction
- Peripheral artery disease
If you experience any symptoms of high blood pressure, call 911 or visit the nearest emergency hospital right away to help avoid these life-altering and sometimes fatal complications.
Some research has also found that smoking may blunt the effects of blood pressure medication such as amlodipine thereby reducing the drugs ability to mitigate high blood pressure and stiffening of the arteries.
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What Are The Long
Asked by Paul G Knox 337 votes
In small doses, like those contained in the gum, nicotine is generally considered safe. But it does have stimulant properties that can raise blood pressure, increase heart rate and constrict blood vessels. Onelarge study from 2010 found that compared with people given a placebo, people who used nicotine-replacement therapies had a higher risk of heart palpitations and chest pains.
That is one reason that nicotine gum should, ideally, be used for no longer than four to six months, said Lauren Indorf, a nurse practitioner with the Cleveland Clinics Tobacco Treatment Center. Yet up to 10 percent of people use it for longer periods, in some cases for a decade or more, she said.
Some studies have raised speculation that long-term use of nicotine might also raise the risk of cancer, though it has mostly involved laboratory and animal research, and there have been no long-term randomized studies that involve people and specifically address the question. One recent report that reviewed the evidence on nicotine-replacement therapy and cancer concluded that the risk, if any, seems small compared with continued smoking.
Ultimately, the biggest problem with the use of nicotine gum for lengthy periods is that the longer you stay on it, the longer you remain dependent on nicotine and the greater your odds of a smoking relapse, Ms. Indorf said. What if the gum is not available one day? she said. Your body is still relying on nicotine.
Typical Dosing For Nicotine Patch
Your starting dose of nicotine patch depends on how many cigarettes you typically smoke daily. The typical dose is to apply one patch to skin once daily.
If you smoke more than 10 cigarettes daily:
- Week 1-4: Step 1 – use one 21 mg patch daily
- Week 5-6: Step 2 – use one 14 mg patch daily
- Week 7-8: Step 3 – use one 7 mg patch daily
If you smoke 10 or less cigarettes daily:
- Week 1-6: Step 2 – use one 14 mg patch daily
- Week 7-8: Step 3 – use one 7 mg patch daily
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Getting The Most From Nicotine Replacement Therapy
Nicotine replacement therapy only deals with the physical dependence. Its not meant to be the only thing you use to help you quit smoking. Youll need other methods that help with the psychological part of tobacco, such as a quit program. Use these support systems during treatment with NRT and for at least a few months after you quit. Studies have shown that this approach pairing NRT with a program that helps to change behavior can improve your chances of quitting and staying quit compared to approaches that use only one method.
The best time to start NRT is when you first quit. Often people first try to quit tobacco on their own then decide to try NRT a day or more into quitting. This does not give you the greatest chance of success, but dont let this discourage you. There are many options for quitting and staying quit. Just remember that it often takes many tries.
The Food and Drug Administration has approved the NRT products discussed here as effective aids for helping people quit smoking. None of these products has been FDA-approved specifically to help people quit smokeless tobacco. Still, studies are being done, and some have shown the lozenge form may help.
What Is Light Average And Heavy Smoking
Most nicotine replacement therapy products recommendations are based on how much you smoke. But theres no formal category in any textbook or group that defines how much smoking is considered light, average, or heavy smoking.
These are general guidelines:
- Light smoking: Fewer than 10 cigarettes per day
- Heavy smoking: A pack a day or more
- Average smoking falls in between.
Stopping Nicotine Replacement Therapy
Nicotine replacement therapy is meant to be used for a limited period of time. Use should be tapered down before NRT is stopped. Studies to date have not shown that extending NRT use longer than the recommended time greatly impacts quit success. However, long-term NRT use is still preferable to smoking.
Research is still being done to refine the use of NRT. If you feel that you need NRT for a different length of time than is recommended, its best to discuss this with your health care provider.
Can You Get Too Much Nicotine From Nrt
Nicotine overdose is rare, but possible. Nicotine replacement therapy products are labeled to match the amount of nicotine you get from NRT to the amount you got from tobacco. If used this way, you should get a nicotine dose fairly close to what youve been getting. You dont want to get more than that, because higher doses of nicotine can cause harm. To avoid this, follow dosing instructions carefully. Also, dont use heat on the skin near your nicotine patch you could absorb more nicotine due to the increased blood supply.
Nicotine absorbs through the skin and mucous membranes, so you must store and dispose of your NRT safely. Nicotine overdose can be fatal, but this is rare and requires taking in very high doses of nicotine. Overdose is more of a problem in children and pets because of their smaller size. Keep NRT and used gum, patches, empty cartridges, bottles, etc., safely away from children and pets. Never drop them on the street or in open trash cans where kids and animals can reach them.
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Does Quitting Smoking Lower Blood Pressure
Quitting smoking along with making small changes to your habits like eating a low sodium diet, getting regular exercise, maintaining a healthy weight, and limiting alcohol intake can lower your blood pressure by 10 to 20 mmHG or more.
Quitting earlier is best to avoid irreversible damage to our blood vessels but even if you are a longtime smoker it is never too late to quit. Smoking also increases your risk of other conditions like lung cancer, COPD, and emphysema so the health benefits of quitting are enormous.
In the United States, the estimated number of tobacco smokers has dropped, as a result of tobacco-control efforts, from 45.1 million smokers in 2005 to 36.5 million smokers in 2017. That number is expected to continue to drop although the rise in use of smokeless tobacco has caused some opposition.
Where Is The Best Place To Put A Nicotine Patch On Your Body
Put one patch on a clean, dry area of skin on your upper body that isnt covered with hair, such as your stomach, upper arm or side. Do not put the patch on burned, cut, or sore skin. To apply the patch, place the sticky side on your skin and press it firmly with the palm of your hand for 10 seconds.
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What Happens After 5 Days Of Not Smoking
Nicotine is completely eliminated from the body and as a result nicotine withdrawal symptoms will have reached their peak. 5 to 10 days: The average smoker will begin to notice a reduction in the number of nicotine cravings experienced in a day 2 to 12 weeks: Your circulation starts to improve.
Types Of Nicotine Replacement Therapy
The US Food and Drug Administration has approved 5 forms of nicotine replacement therapy :
Note that the patch, gum, and lozenge can be purchased over the counter, while the nasal spray and inhaler require a prescription.
The most important thing to do with any form of NRT is read and follow the package instructions very carefully.
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What Can I Replace Smoking With
They dont take a lot of effort or time, but theyre enough to replace the habit of grabbing for a cigarette.
- Drink a glass of water.
- Eat a dill pickle.
- Suck on a piece of tart candy.
- Eat a popsicle or wash and freeze grapes on a cookie sheet for a healthy frozen snack.
- Floss and brush your teeth.
- Chew gum.
What Do The Numbers Mean
Blood pressure is measured by two numbers. The first number is called the systolic pressure . This is your blood pressure when your heart is squeezing blood out. The second number is called the diastolic pressure . This is the pressure between heartbeats when your heart is filling with blood.
Normal blood pressure is less than 130 over 85 . High blood pressure is 140 over 90 mm Hg or higher. If your blood pressure is between 120 over 80 mm Hg and 140 over 90 mm Hg, you have something called prehypertension
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Nicotine Replacement Therapy Causes An Increase In Cardiovascular Events During A 52
Treatment with NRT during a brief, 4-week, follow-up period does not appear to put patients at risk of cardiovascular disease. However, at 52 weeks, there was an increase in cardiovascular events for patients prescribed NRT, compared with those receiving smoking cessation advice only.
Singapore, 27th April, 2017. Tobacco smoking is now the second leading risk factor for heart disease worldwide,1 killing nearly six million people annually2. In the United Kingdom alone, 80,000 deaths in persons aged over 35 have been linked to smoking, accounting for 17% of deaths in 20143.
There is evidence to support nicotine replacement therapy in stopping smoking, and many guidelines recommend it as a first-line treatment for people seeking medical assistance to quit4-6. In 2011, NRT was the most common aid to quit smoking prescribed in England7. The use of NRT helped 500,000 smokers quit in 2015 the highest number on record8.
Who are the people who seek NRT to quit smoking? It is well established that people who are more nicotine-dependent are those who seek NRT help9. Should we be treating a nicotine-dependent population with more nicotine? We are aware of the harm caused by tobacco smoke, but the contribution of nicotine to cardiovascular disease is less clear.
The increase in cardiovascular events seen in high-risk patients on long-term NRT highlights the need for further investigation into the safety of the long-term use of this treatment.
How Does Smoking Affect Your Health And Your Blood Pressure
Each cigarette you smoke causes a temporary rise in blood pressure. Smoking damages the walls of your blood vessels, leading to , where fat is laid down in your arteries walls, making the arteries narrower. It also makes your blood more likely to clot and forces your heart to work harder. These changes can lead to and .
also causes narrowing of the arteries. So if you have high blood pressure and you smoke, the process happens much faster, dramatically raising your risk of a heart attack or stroke.
Smoking also has the more well-known effects on your lungs, stomach, mouth, throat and skin, causing cancer and pre-mature ageing, and can even effect your bones and your reproductive system.
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How Do I Know What Nrt Dose To Use Based On My Smokeless Tobacco Use
NRT products are supposed to roughly match the amount of nicotine you typically took in through tobacco. It can be more of a challenge to get the dose right for smokeless tobacco users, since NRT products are labeled for people who smoke.
Certain types of NRT may help more than others. If you look at the way the tobacco is used, nicotine gum and lozenges are most like using smokeless tobacco. They also let you control your dose to help keep nicotine cravings down. To avoid withdrawal symptoms, you want to aim for a nicotine dose fairly close to what you got from snuff or tobacco use.
These are general guidelines:
- A heavy user is a person who uses more than 3 cans of snuff or 3 pouches of tobacco a week, and would typically use the higher doses of NRT .
- Those who use 2 to 3 cans or pouches per week would usually try the moderate doses.
- Those who use less than 2 would start with the lowest doses of NRT.
If youve decided to try NRT, discuss your dose with a health care provider before you quit tobacco.