Page 20 - Delaware Medical Journal - March 2016

Tobacco Cessation
for Patients with Coronary Artery Disease
Denise Taylor, MS, RD; Elisabeth Bradley, MS, APN; Stephen Meng, MD; Jhapat Thapa, MD; Edward Goldenberg, MD
TABLE 1: Effects of Neurotransmitters Influenced by Nicotine
NEUROTRANSMITTERS
EFFECTS
Dopamine
Pleasure
Norepinephrine
Appetite suppression
Acetylcholine
Arousal, cognitive enhancement
Vasopressin
Memory
Serotonin
Mood modulation
B-endorphin
Anxiety reduction
IntroductionThis article presents the resources available in
Delaware for the patient who smokes and wants to quit and reviews for the clinician the safety of using nicotine replacement therapy in patients with acute and chronic coronary artery disease (CAD).
The control of cardiovascular risk factors is the key to primary and secondary prevention of, not only vascular disease, but also most chronic diseases that affect our patients. Unfortunately, the success of clinicians in achieving control of hypertension, hyperlipidemia, diabetes mellitus, obesity, and tobacco addiction leaves room for improvement. The incidence of active tobacco use in patients presenting with acute coronary syndrome (ACS) varies from
30 percent to as high as 50 percent.1,2 The successful quit rate varies and those who are most successful use the evidence-based treatment of tobacco cessation medications and counseling.
A systematic review strongly suggests that quitting smoking has the greatest impact on mortality and morbidity in patients with
atherosclerotic cardiovascular disease (95 percent, CI 0.58-0.71).1 This 36 percent reduction is compared to other secondary prevention therapies, such as use of statins for lowering cholesterol (29 percent reduction), aspirin (15 percent reduction), beta blockers (23 percent reduction) or ACE inhibitors (23 percent reduction) which have received greater attention in recent years.3
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Del Med J | March 2016 | Vol. 88 | No. 3