戒烟药物的心血管不良反应

戒烟可降低心血管疾病发生和死亡风险,是心血管疾病二级预防的重要内容。吸烟是一种慢性成瘾性疾病,戒烟过程中常因戒断症状导致复吸,在戒烟过程中需要心理支持治疗和戒烟药物辅助治疗。许多随机对照临床试验证实,戒烟心理辅导有助于患有心血管疾病吸烟者的戒烟。但很少有临床试验证实戒烟药物在心血管疾病患者应用的安全性及有效性。由于尼古丁替代治疗,以及缓释安非他酮和伐尼克兰均可引起交感神经兴奋,理论上增加心肌作功,提高心肌耗氧量;其中尼古丁替代治疗还可能引起内皮功能障碍,使冠状动脉收缩,心肌供氧量减少,因此,越来越多的研究者开始关注合并心血管疾病吸烟者中戒烟药物应用的安全性。

Cardiovascular adverse reaction of pharmacologic agents for cessation

Smoking cessation can reduce morbidity and mortality of cardiovascular disease（CVD）, which is important in CVD secondary prevention. Smoking is a chronic addiction disease, smoking cessation lead to relapse, often due to withdrawal symptoms. Psychological support and pharmacologic agents for cessation are needed during the smoking cessation process. Multiple randomized, controlled clinical trials demonstrated the benefits of counseling patients with CVD on smoking cessation. In contrast, relatively few clinical trials tested the safety or efficacy of pharmacotherapy for smokers with CVD. Researchers raised concerns about the safety of NRT, champix and sustained-release bupropion in patients with CVD, because both agents can have sympathetic activity and can theoretically increase myocardial work, and NRT might also aggravate endothelial dysfunction, and reduce the myocardial oxygen supply through coronary vasoconstriction .So more and more doctors has paid attention on the safety of pharmacotherapy in smokers with CVD.