Guidelines for secondary prevention of cardiovascular disease from the American Heart Association and the American College of Cardiology call for complete smoking cessation and complete avoidance of environmental tobacco smoke. While the second goal may be difficult to accomplish, a new randomized trial with 714 patients provides strong evidence that varenicline (Chantix, Champix) is effective for helping people with heart disease stop smoking ( level 1 [likely reliable] evidence). Though varenicline has been widely tested in healthy individuals, this is the first trial specifically addressing smoking cessation in patients with stable cardiovascular disease. Participants were randomized to varenicline 1 mg orally twice daily vs. placebo for 12 weeks and were followed for 52 weeks. All patients received smoking cessation counseling. Carbon monoxide-confirmed continuous abstinence rates were significantly higher for varenicline during weeks 9-12 (47% vs. 13.9%, p < 0.0001, NNT 4) and during weeks 9-52 (19.2% vs. 7.2%, p < 0.0001, NNT 9). There were no significant differences in all-cause mortality, cardiovascular events, or other serious adverse events, but low event rates limit the study’s power for safety outcomes. The discontinuation rate was higher in the varenicline group (9.6% vs. 4.3%, p < 0.05, NNH 18). The most common adverse events included nausea, headache, and insomnia (Circulation 2010 Jan 19;121(2):221).
For more information, see the Varenicline and Tobacco use disorder topics in DynaMed.
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In Pregnant Patients with Antiphospholipid Antibodies and Recurrent Pregnancy Loss, Adding Heparin to Aspirin Therapy May Increase Live Births
Guidelines from the American College of Chest Physicians (ACCP) recommend heparin plus aspirin to prevent recurrent pregnancy loss in women with antiphospholipid antibodies. The recommendation was based in part on a 2005 Cochrane review. A recent systematic review, including 1 newer trial, adds support to this practice and quantifies the size of the benefit. In 5 trials with 334 patients (mean age 33 years), the live birth rate was 74% with heparin plus aspirin vs. 56% with aspirin alone (pooled relative risk 1.3, p = 0.022) (level 2 [mid-level] evidence). For the combination of heparin and aspirin, the NNT to achieve one live birth was 6. There were no significant differences between treatment groups regarding frequency of pre-eclampsia, preterm labor, or birth weight (Rheumatology (Oxford) 2010 Feb;49(2):281).
For more information, see the Antiphospholipid antibody syndrome topic in DynaMed.