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FDA Places Smokers Between Proverbial Rock and Hard Place

Posted Jun 16 2011 11:58pm
In yet another announcement, the FDA today warned of an increase risk for 2nd heart attack & new peripheral arterial disease (PAD) in smokers who've already had a heart attack and are taking Chantix (varenicline) to help stop smoking .  We've known for quite some time that tobacco use increases one's risk for heart attacks, strokes & PAD.  We've also known for quite some time that those who already suffer from one of the aforementioned are at increased risk for a 2nd similar event and/or new vascular event.  That's why it's so important for smokers to quit smoking and non-smokers to never start (or be chronically exposed to second-hand smoke).

With that said, varenicline does help smokers quit smoking.  But so does bupropion and replacement nicotine without increasing cardiovascular risk (and without increasing suicide risk, yet another strike against varenicline).  But as I mentioned yesterday, don't stop taking any meds abruptly.  Instead, discuss your options w/your family physician.

And don't forget to consider relative risk vs absolute risk.  While those who received varenicline had approximately twice the risk of heart attacks, etc, the absolute risk was only 4 more per ~350 (from 3/350 to 7/353).  Therefore, the number needed to harm (NNH) is 100.  In other words, 100 smokers would have to take varenicline for one year for one to have a cardiovascular event.  You should compare that number to your risk for a heart attack (see both Framingham & Reynolds Risk ).

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