Smoking cessation meds and your heart

Dear Dr. Eva,

I am a 60-year-old smoker and a diabetic. I have been taking Chantix for three years because it helps me smoke less. I understand this is usually a short-term drug. My doctor continues to prescribe it for me at my request. If I take it, I smoke one pack a day. If I don’t take it, I smoke two packs per day.

Now I’m seeing all over the Internet that Chantix may cause heart attacks. I have tried the other meds for nicotine addiction and they don’t work for me. My doctor says she is nervous about keeping me on this medication but will continue if I insist. Should I insist?

Addicted

Dear Addicted,

To answer your question, I’ll start with my recommendation. Overall I think the risk to your heart of the second pack per day is greater than the risk your heart from the Chantix. However, if there is any other way you can get down to one pack a day or less without the Chantix, that would be preferable to taking the Chantix.

The other medications for smoking cessation that I would like you to make sure you have tried are:

1) Zyban, also sold under another brand name as Wellbutrin, or under the generic name bupropion and

2) Nicotine replacement. There are many forms of nicotine replacement including a nicotine inhaler in the form of a cigarette, nicotine gum, nicotine lozenges, and nicotine patches.

A recent study did show a higher risk for cardiovascular events (meaning heart attack or stroke) in people taking Chantix than in people taking placebo (a pill containing no medicine). The rate of cardiac events among people taking Chantix was 1.06 percent, which is 10 events for every 1000 people. The risk of cardiac events among people taking placebo was 0.8 percent or eight events for every 1000 people. So in each group of 1000, two people, or one in 500, had a heart attack or stroke which might have been caused by Chantix.

The only reason this difference was statistically significant was that this was a meta-analysis. A meta-analysis is a statistical analysis done by combining the results of multiple studies. The purpose is, by looking at larger numbers, to see if results that were too small to be significant in the individual studies might appear significant when all the studies are considered together. In this case, the meta-analysis combined 14 earlier studies with a total of 8000 patients. An increased cardiac risk from Chantix had been found in only one of these 14 studies, but when the 14 studies were combined the risk then appeared significant.

It’s important to remember that statistically significant and clinically significant are not necessarily the same thing. You, as a 60-year-old smoker, have about a one in five risk of a cardiac event in the next five years. Those odds may not sound bad to you – one in five does not sound all that awful – but it means that the risk of you having a stroke or heart attack from being a diabetic who smokes are 100 times higher than the risk of you having a heart attack from taking Chantix. Decreasing your cardiac risk in other ways, such as by making sure that your diabetes is well controlled, that your blood pressure and cholesterol are normal, and that you take a baby aspirin daily (unless you are allergic to it or there is another medical reason you should not), will all do more to preserve your health than stopping Chantix would do.

Dr. Eva

Ask Dr. Eva is distributed by Healthy Living News. Dr. Eva Hersh is chief medical officer at Chase Brexton Health Services. Email comments and questions to [email protected] or write to Eva Hersh MD, Chase Brexton Health Services, 1001 Cathedral St., Baltimore, MD 21201

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