“This study finds that in the general population of smokers, the benefit of improved cardiovascular health from pharmacotherapy-assisted smoking cessation exceeds any risk of medication-induced cardiovascular harm.” said lead author Neal Benowitz, MD, professor of medicine and chief of clinical pharmacology at UCSF.
The study was published online April 9 in JAMA Internal Medicine.
Cigarette smoking is associated with a greater risk of heart attack, stroke, vascular disease, atrial fibrillation, sudden death and worsening heart failure, and according to the CDC, nearly seven out of 10 smokers reported a desire to quit.
National guidelines recommend smoking cessation pharmacotherapy for smokers trying to quit, with options including the drugs varenicline, bupropion or the nicotine replacement therapy patch. A review by the US Department of Health and Human Services found that using one of these methods approximately doubles the likelihood of a smoker’s long-term abstinence from tobacco compared with placebo.
But many clinicians remain hesitant to prescribe these drugs because of potential cardiovascular harm. There were initial concerns, though now dispelled, on the risk of heart attack if a person smoked while wearing a nicotine patch. Bupropion can increase blood pressure, and there have been mixed findings on varenicline and cardiovascular event risk.

Overall, few major adverse cardiovascular events occurred during treatment and follow up, Benowitz said, and there were not significant differences by treatment. Incidents during treatment and immediately after were 0.2 percent overall, and 0.6 percent overall after one year. No significant treatment differences were seen in time to cardiovascular events, blood pressure or heart rate. The researchers conclude that there is no evidence that smoking cessation therapies increased the risk of serious cardiovascular events.
In fact, Benowitz says, “Quitting smoking is arguably the most important action a smoker can take to reduce the risk of cardiovascular disease.”