哮喘联盟

   摘要
   背景：戒烟与许多健康情况和生活质量改善相关。戒烟药物也被推荐用以增加戒烟可能性。但是，戒烟治疗可能增加戒烟期间心血管疾病（CVD）事件风险，这一历史性问题又重新受到了关注。我们旨在采用一个网络meta分析，来调查三种获批戒烟治疗（尼古丁替换治疗（NRT）、安非他酮和伐尼克兰）是否与CVD事件风险增加有限。
   方法与结果：我们检测了十个电子数据库，与发表随机对照临床研究(RCT)的作者进行了沟通，并访问了内部食品药品管理局（FDA）报告。我们入组了包括3种戒烟疗法并报道了CVD结果的任何RCT。63项符合条件的RCTs中包括21个NRT RCTs，28个安非他酮RCTs和18个伐尼克兰RCTs，我们发现安非他酮(RR 0.98, 95% 可信区间[CIs], 0.54-1.73)或伐尼克兰(RR 1.30, 95% CI, 0.79-2.23)未增加所有CVD事件风险。而较少不良反应的NRT与CVD事件风险增加有关(2.29, 95% CI, 1.39-3.82)。当我们检查主要不良心血管事件（MACE）时，我们发现安非他酮(RR 0.45, 95% CI, 0.21-0.85)有保护作用，伐尼克兰(RR 1.34, 95% CI, 0.66-2.66)和NRT(RR 1.95, 95% CI, 0.26-4.30)无明显危害证据。
   结论：戒烟治疗似乎并不增加严重CVD事件风险。
 

（刘国梁 审校）
Circulation. 2013 Dec 9. [Epub ahead of print]

Cardiovascular Events Associated with Smoking Cessation Pharmacotherapies: A Network Meta-Analysis.

Mills EJ, Thorlund K, Eapen S, Wu P, Prochaska JJ.

ABSTRACT
BACKGROUND: Stopping smoking is associated with many important improvements in health and quality of life. Use of cessation medications is recommended to increase the likelihood of quitting. However, there is historical and renewed concern that smoking cessation therapies may increase the risk of cardiovascular disease (CVD) events associated within the quitting period. We aimed to examine whether the three licensed smoking cessation therapies: nicotine replacement therapy (NRT); bupropion, and; varenicline and were associated with an increased risk of CVD events using a network meta-analysis.
METHODS AND RESULTS: We searched ten electronic databases, and made communication with authors of published randomized clinical trials (RCT), and accessed internal US Food and Drug Administration (FDA) reports. We included any RCT of the 3 treatments that reported on CVD outcomes. Among 63 eligible RCTs involving 21 NRT RCTs, 28 bupropion RCTs and 18 varenicline RCTs, we found no increase in the risk of all-CVD events with bupropion (RR 0.98, 95% Confidence Intervals [CIs], 0.54-1.73) or varenicline (RR 1.30, 95% CI, 0.79-2.23). There was an elevated risk associated with NRT that was predominantly driven by less serious events (2.29, 95% CI, 1.39-3.82). When we examined major adverse cardiovascular events (MACE) events, we found a protective effect with bupropion (RR 0.45, 95% CI, 0.21-0.85) and no clear evidence of harm with varenicline (RR 1.34, 95% CI, 0.66-2.66) or NRT (RR 1.95, 95% CI, 0.26-4.30).
CONCLUSIONS: Smoking cessation therapies do not appear to raise the risk of serious CVD events.

Circulation. 2013 Dec 9. [Epub ahead of print]