Varenicline Reduces Daily Cigarette Count in Smokers with Heart Conditions

Any condition that suddenly blocks blood to the heart, such as heart attack and unstable angina, is under the umbrella of acute coronary syndrome (ACS), and an ongoing trial is reporting that a medication can help reduce one of the primary risk factors.

Smoking puts the population at risk for a seemingly endless list of health problems, yet previous studies have shown that less than one-third of patients discharged from the hospital for ACS actually remain abstinent from smoking. Varenicline, marketed under the name Chantix, was approved by the US Food and Drug Administration (FDA) in 2006 to stop cigarette smokers from lighting up. The ongoing EVITA (Evaluation of Varenicline in Smoking Cessation for Patients Post-Acute Coronary Syndrome) trial continues to analyze patient outcomes on the medication.

Mark J. Eisenberg, MD, MPH, FACC, FAHA, unveiled that latest results during a presentation at the American Heart Association 2015 Scientific Sessions (AHA 2015) in Orlando, Florida.

All of the participants were smokers, had been hospitalized for ACS, and smoke at least 10 cigarettes a day for a year prior to the hospitalization. About 75% were male and the average age was 55. The study aimed to assess the efficacy of varenicline in smokers who were hospitalized for ACS. Over 90% of the patients had been hospitalized for myocardial infraction not long before their first treatment. Eisenberg explained that as far as the team knows, this is the highest risk group of patients to be tested with varenicline.

“Importantly, these patients smoked over three decades,” explained Eisenberg, from the Jewish General Hospital in Montréal, Canada. Actually, the average smoking duration was 36 years, to be exact.

For 12 weeks, the participants either received varenicline (153 patients) or placebo (151 patients). They had clinical visits and telephone follow-ups at the 4-, 12-, and 24-week marks. The hopeful outcome was that there would be no more smoking by week 24.

In the varenicline group, patients showed more than 50% in daily cigarettes at all three check-in points compared to baseline.

Eisenberg pointed out that the study didn’t aim to look at safety endpoints, but the evidence added to the growing support that it is. There was only one neuropsychiatric event when a patient was hospitalized for depression 25 days after one dose of varenicline.

“Continuous abstinence is better,” Eisenberg said, and explained that morbidity and mortality substantially increased among patients who continue to smoke following ACS.

“Varenicline, initiated in-hospital following ACS, and in conjunction with low-intensity counseling, is efficacious for smoking cession,” Eisenberg concluded.