The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease
Open accessAbstract
BACKGROUND: Transdermal nicotine therapy is widely used to aid smoking cessation, but there is uncertainty about its safety in patients with cardiac disease. METHODS: In a randomized, double-blind, placebo-controlled trial at 10 Veterans Affairs medical centers, we randomly assigned 584 outpatients (of whom 576 were men) with at least one diagnosis of cardiovascular disease to a 10-week course of transdermal nicotine or placebo as an aid to smoking cessation. The subjects were monitored for a total of 14 weeks for the primary end points of the study (death, myocardial infarction, cardiac arrest, and admission to the hospital due to increased severity of angina, arrhythmia, or congestive heart failure); the secondary end points (admission to the hospital for other reasons and outpatient visits necessitated by increased severity of heart disease); any side effects of therapy; and abstinence from smoking. RESULTS: There were 48 primary and 78 secondary end points noted in a total of 95 subjects. At least one of the primary end points was reached by 5.4 percent of the subjects in the nicotine group and 7.9 percent of the subjects in the placebo group (difference, 2.5 percent; 95 percent confidence interval, -1.6 to 6.5 percent; P=0.23). In the nicotine group, 11.9 percent of the subjects had at least one of the secondary end points, as compared with 9.7 percent in the placebo group (difference, 2.2 percent; 95 percent confidence interval, -2.2 to 7.4 percent; P= 0.37). After 14 weeks the rate of abstinence from smoking was 21 percent in the nicotine group, as compared with 9 percent in the placebo group (P=0.001), but after 24 weeks the abstinence rates were not significantly different (14 percent vs. 11 percent, P= 0.67). CONCLUSIONS: Transdermal nicotine does not cause a significant increase in cardiovascular events in high-risk outpatients with cardiac disease. However, the efficacy of transdermal nicotine as an aid to smoking cessation in such patients is limited and may not be sustained over time.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Nicotine replacement has shown no adverse effect on outcomes in patients with cardiac disease.
“and nicotine replacement has shown no adverse effect on outcomes in patients with cardiac disease.246,247”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [246]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Anthonisen, N. R. (1994) · JAMA · doi:10.1001/jama.272.19.1497 · Cited by 1,820 · see citing works
Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire
Fagerstrom, K. O., & Schneider, N. G. (1989) · Journal of Behavioral Medicine · doi:10.1007/bf00846549 · Cited by 1,598 · see citing works
Morrow, J. D., Frei, B. B., Longmire, A. W., Gaziano, J. M., Lynch, S. M., Shyr, Y., Strauss, W., Oates, J. A., & Roberts, L. J. (1995) · New England Journal of Medicine · doi:10.1056/nejm199505043321804 · Cited by 1,340 · see citing works
Pharmacologic Aspects of Cigarette Smoking and Nicotine Addiction
Oates, J. A., Wood, A. J. J., & Benowitz, N. L. (1988) · New England Journal of Medicine · doi:10.1056/nejm198811173192005 · Cited by 963 · see citing works
A Case-Management System for Coronary Risk Factor Modification after Acute Myocardial Infarction
DeBusk, R. F., Miller, N. H., Superko, H. R., Dennis, C. A., Thomas, R. J., Lew, H. T., Berger, W. E., Heller, R. S., Rompf, J., Gee, D., et al. (1994) · Annals of Internal Medicine · doi:10.7326/0003-4819-120-9-199405010-00001 · Cited by 745 · see citing works
The effectiveness of the nicotine patch for smoking cessation. A meta-analysis
Fiore, M. C. (1994) · JAMA · doi:10.1001/jama.271.24.1940 · Cited by 534 · see citing works
Predicting Smoking Cessation: Who Will Quit With and Without the Nicotine Patch
Kenford, S. L. (1994) · JAMA · doi:10.1001/jama.271.8.589 · Cited by 405 · see citing works
Smoking Cessation after Acute Myocardial Infarction: Effects of a Nurse-Managed Intervention
Taylor, C. B., Houston-Miller, N., Killen, J. D., & DeBusk, R. F. (1990) · Annals of Internal Medicine · doi:10.7326/0003-4819-113-2-118 · Cited by 394 · see citing works
Higher levels of nicotine in arterial than in venous blood after cigarette smoking
Henningfield, J. E. (1993) · Drug and Alcohol Dependence · doi:10.1016/0376-8716(93)90030-t · Cited by 370 · see citing works
Allred, E. N., Bleecker, E. R., CHAITMAN, B. R., Dahms, T. E., Gottlieb, S. O., Hackney, J. D., Pagano, M., Selvester, R. H. S., Walden, S. M., & Warren, J. (1989) · New England Journal of Medicine · doi:10.1056/nejm198911233212102 · Cited by 327 · see citing works
The Health consequences of smoking; cardiovascular disease : a report of the Surgeon General
Shopland, D. R. (1983) · Cited by 274 · see citing works
Nicotine Medications for Smoking Cessation
Henningfield, J. E. (1995) · New England Journal of Medicine · doi:10.1056/nejm199511023331807 · Cited by 237 · see citing works
Benowitz, N. L., FitzGerald, G. A., Wilson, M., & Zhang, Q. (1993) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(93)90431-y · Cited by 195 · see citing works
Cigarette smoking and hemostatic function
FitzGerald, G. A., Oates, J. A., & Nowak, J. (1988) · American Heart Journal · doi:10.1016/0002-8703(88)90648-5 · Cited by 169 · see citing works
Nicotine Replacement Therapy for Patients With Coronary Artery Disease
(1994) · Archives of Internal Medicine · doi:10.1001/archinte.154.9.989 · Cited by 165 · see citing works
Rigotti, N. A., McKool, K. M., & Shiffman, S. (1994) · Annals of Internal Medicine · doi:10.7326/0003-4819-120-4-199402150-00005 · Cited by 164 · see citing works
Christen, A. G., Beiswanger, B. B., MAU, M. S., Walker, C. H., Hatsukami, D. K., ALLEN, S. S., Huber, M., Jensen, J., Rennard, S. I., Daughton, D. M., et al. (1991) · JAMA · doi:10.1001/jama.266.22.3133 · Cited by 87 · see citing works
Intravenous nicotine replacement suppresses nicotine intake from cigarette smoking.
Benowitz, N. L., & Jacob, P. (1990) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1016/s0022-3565(25)12693-1 · Cited by 81 · see citing works
Fredrickson, P. A., Lee, G. M., Wingender, L., Hurt, R. D., Croghan, I. T., Lauger, G., Offord, K. P., & Gomez‐Dahl, L. C. (1995) · Psychopharmacology · doi:10.1007/bf02246542 · Cited by 65 · see citing works
Chronic nicotine ingestion and atrial fibrillation.
STEWART, P. M., & Catterall, J. R. (1985) · Heart · doi:10.1136/hrt.54.2.222 · Cited by 62 · see citing works
Effect of nicotine on coronary blood‐flow in man
Kaijser, L., & Berglund, B. (1985) · Clinical Physiology · doi:10.1111/j.1475-097x.1985.tb00767.x · Cited by 59 · see citing works
White Blood Cell Count and Stroke Incidence and Death
Gillum, R. F., Ingram, D. D., & Makuc, D. M. (1994) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a117095 · Cited by 52 · see citing works
Cholesterol Changes in Smoking Cessation Using the Transdermal Nicotine System
ALLEN, S. S., Hatsukami, D. K., Gorsline, J., Christen, A. G., Rennard, S. I., Heatley, S., Fortmann, S. P., Hughes, J., Glover, E. D., Repsher, L. H., et al. (1994) · Preventive Medicine · doi:10.1006/pmed.1994.1026 · Cited by 45 · see citing works
Myocardial infarction and nicotine patch: a contributing or causative factor?
DaCosta, A., GUY, J. M., Tardy, B., Gonthier, R., Denis, L., Lamaud, M., Cerisier, A., & Verneyre, H. (1993) · European Heart Journal · doi:10.1093/eurheartj/14.12.1709 · Cited by 41 · see citing works
Acute Myocardial Infarction While Using the Nicotine Patch
Ottervanger, J. P., Festen, J., de Vries, A. G., et al. (1995) · CHEST Journal · doi:10.1378/chest.107.6.1765 · Cited by 38 · see citing works
Cerebral arterial narrowing with nicotine patch
Jackson, M. C. (1993) · The Lancet · doi:10.1016/0140-6736(93)92323-l · Cited by 36 · see citing works
Atrial Fibrillation While Chewing Nicotine Gum
Rigotti, N. A. (1986) · JAMA · doi:10.1001/jama.1986.03370080040015 · Cited by 35 · see citing works
Severity of Angiographically Proven Coronary Artery Disease Predicts Smoking Cessation
Frid, D. J., Ockene, I. S., Ockene, J. K., et al. (1991) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(18)30927-9 · Cited by 34 · see citing works
Myocardial Infarction in a Patient Who Smoked while Wearing a Nicotine Patch
Warner, J. G., & Little, W. C. (1994) · Annals of Internal Medicine · doi:10.7326/0003-4819-120-8-199404150-00023 · Cited by 30 · see citing works
Stroke following Application of a Nicotine Patch
Pierce, J. R. (1994) · Annals of Pharmacotherapy · doi:10.1177/106002809402800320 · Cited by 27 · see citing works
Nicotine patches may not be safe
Arnaot, M. R. (1995) · BMJ · doi:10.1136/bmj.310.6980.663c · Cited by 21 · see citing works
Atrial fibrillation while chewing nicotine gum
Rigotti, N. A. (1986) · JAMA · doi:10.1001/jama.255.8.1018 · Cited by 7 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Hwang SL, Waldholt M. Heart attacks reported in patch users still smoking. Wall Street Journal. June 19, 1992:B1.
Cited by
Sorted by citations
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
Authors/Task Force Members:, Perk, J., De Backer, G., Gohlke, H., Graham, I., Reiner, Ž., Verschuren, M., Albus, C., Benlian, P., Boysen, G., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs092 · Cited by 8,490 · see citing works
2016 European Guidelines on cardiovascular disease prevention in clinical practice
Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M.-T., Corrà, U., Cosyns, B., Deaton, C., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw106 · Cited by 6,457 · see citing works
Effectiveness of brief alcohol interventions in primary care populations
Kaner, E. F., Beyer, F. R., Muirhead, C., Campbell, F., Pienaar, E. D., Bertholet, N., Daeppen, J. B., Saunders, J. B., & Burnand, B. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004148.pub4 · Cited by 1,665 · see citing works
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001168 · Cited by 1,598 · see citing works
Pharmacological interventions for smoking cessation: an overview and network meta-analysis
Cahill, K., Stevens, S., Perera, R., & Lancaster, T. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009329.pub2 · Cited by 1,243 · see citing works
Second Joint Task Force of European (1998) · European Heart Journal · doi:10.1053/euhj.1998.1243 · Cited by 1,131 · see citing works
Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics
Benowitz, N. L. (2009) · Annual Review of Pharmacology and Toxicology · doi:10.1146/annurev.pharmtox.48.113006.094742 · Cited by 979 · see citing works
Nicotine replacement therapy for smoking cessation
Silagy, C., Lancaster, T., Stead, L., Mant, D., & Fowler, G. (2004) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000146.pub2 · Cited by 972 · see citing works
Nicotine replacement therapy for smoking cessation
Stead, L. F., Perera, R., Bullen, C., Mant, D., & Lancaster, T. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000146.pub3 · Cited by 721 · see citing works
Nicotine replacement therapy versus control for smoking cessation
Hartmann-Boyce, J., Chepkin, S. C., Ye, W., Bullen, C., & Lancaster, T. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000146.pub5 · Cited by 697 · see citing works
Virani, S. S., Newby, L. K., Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S. H., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., et al. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.04.003 · Cited by 596 · see citing works
Wilson, K., Gibson, N., Willan, A., & Cook, D. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.7.939 · Cited by 415 · see citing works
Us Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence
Fiore, M. C., & Staff, G. P. A. (2000) · Respiratory Care · doi:10.1177/002013240004501007 · Cited by 346 · see citing works
Lingford-Hughes, A., Welch, S., Peters, L., Nutt, D., & With expert reviewers (in alphabetical order): Ball D, B. N. (2012) · Journal of Psychopharmacology · doi:10.1177/0269881112444324 · Cited by 332 · see citing works
Smoking Status and Risk for Recurrent Coronary Events after Myocardial Infarction
Rea, T. D., Heckbert, S. R., Kaplan, R. C., Smith, N. L., Lemaitre, R. N., & Psaty, B. M. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-137-6-200209170-00009 · Cited by 213 · see citing works
Diretrizes para cessação do tabagismo - 2008
Reichert, J., Araújo, A. J. D., Gonçalves, C. M. C., Godoy, I., Chatkin, J. M., Sales, M. D. P. U., & Santos, S. R. R. D. A. (2008) · Jornal Brasileiro de Pneumologia · doi:10.1590/s1806-37132008001000014 · Cited by 166 · see citing works
Mills, E. J., Wu, P., Lockhart, I., Wilson, K., & Ebbert, J. O. (2010) · Tobacco Induced Diseases · doi:10.1186/1617-9625-8-8 · Cited by 166 · see citing works
F. Piepoli, M. (2017) · International Journal of Behavioral Medicine · doi:10.1007/s12529-016-9583-6 · Cited by 162 · see citing works
Treatment of nicotine addiction: present therapeutic options and pipeline developments
Polosa, R., & Benowitz, N. L. (2011) · Trends in Pharmacological Sciences · doi:10.1016/j.tips.2010.12.008 · Cited by 135 · see citing works
Suissa, K., Larivière, J., Eisenberg, M. J., Eberg, M., Gore, G. C., Grad, R., Joseph, L., Reynier, P. M., & Filion, K. B. (2017) · Circulation: Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.115.002458 · Cited by 109 · see citing works
Smoking cessation in patients with coronary artery disease
Ludvig, J., Miner, B., & Eisenberg, M. J. (2005) · American Heart Journal · doi:10.1016/j.ahj.2004.09.040 · Cited by 87 · see citing works
Smoking cessation interventions and older adults
Doolan, D. M., & Froelicher, E. S. (2008) · Progress in Cardiovascular Nursing · doi:10.1111/j.1751-7117.2008.00001.x · Cited by 85 · see citing works
Nicotine withdrawal and agitation in ventilated critically ill patients
Lucidarme, O., Seguin, A., Daubin, C., Ramakers, M., Terzi, N., Beck, P., Charbonneau, P., & du Cheyron, D. (2010) · Critical Care · doi:10.1186/cc8954 · Cited by 85 · see citing works
Adverse effects and tolerability of medications for the treatment of tobacco use and dependence
Hays, J. T., & Ebbert, J. O. (2010) · Drugs · doi:10.2165/11538190-000000000-00000 · Cited by 74 · see citing works
A randomized trial of nortriptyline combined with transdermal nicotine for smoking cessation
Prochazka, A. V., Kick, S., Steinbrunn, C., Miyoshi, T., & Fryer, G. E. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.20.2229 · Cited by 73 · see citing works
Self-citationThe association of nicotine replacement therapy with mortality in a medical intensive care unit
Lee, A. H., & Afessa, B. (2007) · Critical Care Medicine · doi:10.1097/01.ccm.0000266537.86437.38 · Cited by 64 · see citing works
Lifestyle modification in secondary prevention
Piepoli, M. F., & Villani, G. Q. (2017) · European Journal of Preventive Cardiology · doi:10.1177/2047487317703828 · Cited by 33 · see citing works
Rennard, S. I., & Daughton, D. M. (2014) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2013.11.002 · Cited by 25 · see citing works
Transdermal nicotine for agitation in dementia
Rosin, R. A., Levine, M. D., & Peskind, E. (2001) · The American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200111000-00014 · Cited by 13 · see citing works
- Authors
- Joseph, A. M., Norman, S. M., Ferry, L. H., Prochazka, A. V., Westman, E. C., Steele, B. G., Sherman, S. E., Cleveland, M., Antonuccio, D. O., Hartman, N., & McGovern, P. G.
- Affiliations
- University of Minnesota (US)
- Kansas City VA Medical Center (US)
- VA Loma Linda Healthcare System (US)
- United States Department of Veterans Affairs (US)
- Durham VA Medical Center (US)
- VA Sepulveda Ambulatory Care Center (US)
- Portland VA Medical Center (US)
- VA West Los Angeles Medical Center (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1996-12-12
- Volume
- 335
- Issue
- 24
- Pages
- 1792-1798
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2320130521
- Cited by
- 492
- References
- 32
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 6 · 2021: 12 · 2020: 13 · 2019: 8 · 2018: 12 · 2017: 11 · 2016: 14 · 2015: 9 · 2014: 14 · 2013: 14 · 2012: 24
- FWCI
- 11.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- transdermal nicotine, smoking cessation, heart disease, cardiovascular safety, myocardial infarction, congestive heart failure, cardiac arrhythmias, smoking abstinence, veterans, nicotine therapy
- MeSH terms
- Administration, Cutaneous, Aged, Aged, 80 and over, Analysis of Variance, Cardiovascular Diseases, Double-Blind Method, Female, Humans, Male, Middle Aged, Nicotine, Smoking Cessation, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
