Review Articles
Cardiovascular Toxicity of Nicotine: Implications for Nicotine Replacement Therapy 1,

https://doi.org/10.1016/S0735-1097(97)00079-XGet rights and content
Under an Elsevier user license
open archive

Abstract

This review discusses the known cardiovascular effects of smoking and the effects of nicotine without tobacco smoke and interprets the available data on cardiovascular risk during nicotine replacement therapy (NRT). Nicotine gum and patches are now approved for over the counter sale in the United States. Smokers with cardiovascular disease are advised to seek physician counseling before using nicotine products, but information regarding the safety of these products in such patients is not readily available to most physicians. Nicotine may contribute to cardiovascular disease, presumably by hemodynamic consequences of sympathetic neural stimulation and systemic catecholamine release. However, there are many potential cardiovascular toxins in cigarette smoke other than nicotine. The doses of nicotine obtained by regular cigarette smoking generally exceed those delivered by NRTs, and the cardiovascular effects of nicotine are, in general, more intense when delivered rapidly by cigarette smoking than the slower delivery by transdermal nicotine or nicotine gum. Because the dose–cardiovascular response relation for nicotine is flat, the effects of cigarette smoking in conjunction with NRT are similar to those of cigarette smoking alone. Cigarette smoking increases blood coagulability, a major risk factor for acute cardiovascular events, whereas transdermal nicotine does not appear to do so. Clinical trials of NRT in patients with underlying, stable coronary disease suggest that nicotine does not increase cardiovascular risk. At worst, the risks of NRT are no more than those of cigarette smoking. The risks of NRT for smokers, even for those with underlying cardiovascular disease, are small and are substantially outweighed by the potential benefits of smoking cessation.

(J Am Coll Cardiol 1997;29:1422–31)

Abbreviations

CGRP
calcitonin growth-related peptide
ECG
electrocardiographic
HDL
high density lipoprotein
LDL
low density lipoprotein
NO
nitric oxide
NRT
nicotine replacement therapy
VLDL
very low density lipoprotein

Cited by (0)

This work was supported by Grants DA02277 and DA01696 from the National Institute on Drug Abuse and by NIH Grant RR-00083 from the Division of Research Resources, National Institutes of Health, Bethesda, Maryland; by an Overseas Research Fellowship from the National Heart Foundation of Australia, Canberra; and by Alza Corporation, Palo Alto, California.

1

All editorial decisions for this article, including selection of referees, were made by a Guest Editor. This policy applies to all articles with authors from the University of California San Francisco.