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As a follow-up to the post on e-cigarettes, I intend to write one or two more posts on Nicotine Replacement Therapy.
The Problem with Nicotine
I always thought that it was the tar in cigarettes, not the nicotine, that caused all the health problems associated with smoking. You can imagine how I felt when I found out that nicotine is what the medical profession calls a vasoconstrictor. This means that it can shrink the blood vessels(veins, arteries). If your blood has a tendency to clot, and this condition is untreated, shrinking of the blood vessels can increase the likelihood of blockage.
I always thought that Nicotine Replacement Therapy was beneficial because it helped people to quit smoking. Now it seemed that I was recommending something harmful, and particularly harmful to those suffering from vascular problems!
I felt that I had to do some more research into this subject. Here’s what I found out.
Nicotine – The Report That Caused Concern
The most recent work on the subject is the study conducted at Brown University(Providence, Rhode Island, US) by Dr. Chi Ming Hai in February 2012. One of Dr. Hai’s conclusions was that “long-term consumption of nicotine(by the use of patches, gum, e-cigarettes) is likely to increase the risk of developing atherosclerosis”.
Naturally, I saw in Dr. Hai’s findings a cause for concern.
But my concern turned first into anxiety and then blind panic when I read an article by Christine Hsu in the US publication Medical Daily. It was entitled “Nicotine Promotes Cardiovascular Disease – Benefits Of Smoke-Free Products Questioned”. The article was headed by a photo of some Nicotine gum with the caption “Better quit cold turkey. Nicotine contributes to the progression of cardiovascular diseases”.
The article purported to explain the findings of the Brown University team.
Nicotine – What Other Experts Say
It seems that concern over a possible link between nicotine consumption and cardiovascular problems isn’t new.
In November 2005, a report by the UK Committee on the Safety of Medicines Working Group on Nicotine Replacement Therapy mentioned this early concern:
“When Nicotine Replacement Therapy was initially introduced there were concerns that nicotine could precipitate cardiovascular events[i.e. heart attacks, strokes] in susceptible individuals…”
This concern, however, is eventually dismissed.
“In general the data generated indicates that for smokers who have the stable cardiovascular disease[i.e.those who are not acutely ill] the benefits of using Nicotine Replacement Therapy to quit smoking outweigh any risks there might be with Nicotine Replacement Therapy(itself)…”
Some of the “data generated” in the above quote probably came from research by Neal L. Benowitz and Stephen J. Gourlay, published in the Journal of the American College of Cardiology in 1997. They found that clinical trials of NRT involving patients with underlying stable coronary disease suggested that nicotine does not increase cardiovascular risk. They came to the conclusion that, for smokers(even those with an underlying cardiovascular disease), any risks associated with NRT are substantially outweighed by the benefits of quitting smoking.
Further research on the use of NRT with patients suffering from cardiovascular disease was conducted by Adler and others in 2003(Effectiveness and Tolerance of Early Use NRT in a Coronary Care Unit). Forty smokers were given NRT after admission to hospital with diseases like angina. The authors state that
“…the NRT did not contribute to an increase in ischaemic attacks during the patients stay in the coronary care unit.”
The authors also point out that there were no significant differences in the number of deaths, ischaemic attacks or re-admissions to a hospital during the one year follow up.
Is Nicotine Replacement Therapy Safe?
Can you disregard the findings of the Brown University study?
I say most emphatically No, you can’t.
But you don’t have to panic and throw your patches and gum into the bin either.
The language used in the actual Brown University report is considerably milder than the “sensationalist” language used to talk about its findings in some publications.
In fact, Dr. Hai actually says :
“In my opinion, if taking nicotine for a short space of time can lead to a complete cessation of smoking, then it will be beneficial to take nicotine as a bridge to smoking cessation.”
What Dr. Hai is saying is that it’s OK to use NRT in the short-term to help you to quit smoking, but that it could be positively dangerous to use e-cigarettes, patches or gum as a long-term or permanent substitute for smoking.
So there you have it [- Nicotine Replacement Therapy is OK if it’s used as a means of quitting smoking.
Having said that, I must end with a word of warning.
No one should start Nicotine Replacement Therapy before seeing their doctor.
That does sound a bit extreme, especially as I’m normally a campaigner for moderation.
But the problem is that cardiovascular problems(particularly vascular ones) don’t always produce obvious symptoms. For example, it’s possible to suffer from high blood pressure without realizing it. That’s why it’s best to have a medical check-up, and possibly tests before taking this course of action.