It Might be Dangerous to Quit Smoking

Anyone who's been listening to our podcast or reading our blog for any length of time (even just last week's post on the use of texting to help people quit the smoking habit) knows I'm rabidly anti-smoking.  So what gives with the headline?  Turns out a medication marketed as "Chantix," chemical name varenicline, actually increases the risk of cardiovascular events when taken to assist cigarette smoking cessation efforts.  Yikes.  Just when you thought you were doing something good for your body as well as those around you. 

This study, published in the Canadian Medical Association Journal, is a meta-analysis of 14 of our favorite type of clinical trial (double-blind, placebo controlled, prospective, randomized), where study participants who smoked or used smokeless tobacco either used Chantix to assist their quitting attempt or not.  The studies contained data on cardiovascular events, including ischemia, arrhythmia, congestive heart failure, sudden death, or cardiovascular-related death.

The study concluded that use of Chantix for variable lengths of time ranging from 7 weeks to 52 weeks resulted in a 72% increased risk for a serious cardiovascular event or complication.  Hmmmm.  Rick attempts to be balanced in his interpretation of the data by admitting that we don't know how the quitting attempt impacts on cardiovascular disease risk related to not smoking anymore, but that's provided the quit attempt is both successful and durable.  Big ifs, as anyone who's witnessed smoking cessation efforts will attest.  Recidivism is high amongst smokers, with the majority continuing to smoke or returning to the practice in short order.  My guess is that the aggregate benefit of stopping smoking may not balance against the real and immediate risk of Chantix. 

I argue that previous research we've covered over the years establishes the efficacy of a multifaceted approach to smoking cessation.  Cognitive behavioral therapy, support groups, nicotine replacement, and perhaps use of a medication are known to offer the best chance for successful quitting.  Last week's post also describes another ingenious insertion to this constellation of strategies  with utilization of texting to support and encourage those attempting to stop smoking.  In view of the demonstrated risks of Chantix, why not make a quit attempt by harnessing all the horses and leaving this particular medication by the wayside?  There are other, although admittedly less effective medication choices, but my own predilection is if a serious, comprehensive approach is taken to stop smoking, success without this particular drug is likely.

Genuflecting to both Rick and one of the study's authors who is here at Johns Hopkins, Sonal Singh, I must reveal that both of them say this data doesn't absolutely close the door on Chantix.  Rather, they agree, people who chose to use Chantix should be apprised of the risks and benefits and allowed to make their own choices.  Clearly, continuing to smoke is the most dangerous choice of all.

Other topics this week include (speaking of choices) what women can do to reduce their risk of sudden cardiac death, the appropriateness of stent placement, and the dangers of rural hospitals, all in JAMA.  Until next week, y'all live well.

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5 Comments

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Comments

Samantha F. Hughes August 28, 2013 at 6:53 am

To help you continue how to stop smoking in the few days after you quit, you should avoid drinking beverages that you associate with smoking. Caffeine for instance, as many smokers are usually coffee drinkers. By avoiding these smoking triggers and replacing it with something you normally don’t do while smoking, this can help you to remain smoke-free.

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connie hardesty April 29, 2013 at 3:58 pm

Several years ago, I took chantix for 2 months, stopped smoking but had a bad eye infection (one of the dangers of chantix) and kidney problems. My doctor told me to stop taking chantix, which I did, and the kidney problem went away.

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electronic cigarette February 15, 2013 at 11:26 pm

Hey! I'm at work surfing around your blog from my new iphone 4! Just wanted to say I love reading through your blog and look forward to all your posts! Keep up the outstanding work!

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Darvin September 3, 2011 at 6:52 pm

Thanks for the inihsgt. It brings light into the dark!

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John Terry MD July 11, 2011 at 9:29 am

Not so much a comment on the Chantix article, but the critical access hospital article.
The Crititcal Access Hospital program was intiated to address disproportionately low medicare reinburstments to small hospitals as compared to larger institutions. The difference in income makes operation of any small hospital difficult without participation. The 25 bed designation is not an average, but a regulatory limit to allow participation. The result of these two factors is a contraction of the size of many rural location secondary size medical centers, There is a dramatic variablity in size and function of these hospitals which is much better captured by evaluating their indivdual performance on the Medicare MI, Heart Failure, and Pneumonia outcomes rather than lumping the institutions together. MI results are directly affected by the geographic locations and obvious increase transport time to facilities with catheterization labs which should be no surprise.

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