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Cardiac risk factors and prevention
Original research
Comparative effect of varenicline and nicotine patches on preventing repeat cardiovascular events
  1. Annelies L Robijn1,
  2. Kristian B Filion2,3,
  3. Mark Woodward4,5,
  4. Benjumin Hsu6,
  5. Clara K Chow7,8,
  6. Sallie-Anne Pearson9,
  7. Louisa Jorm6,
  8. Michael O Falster9,
  9. Alys Havard1,9
  1. 1 National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, New South Wales, Australia
  2. 2 Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
  3. 3 Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
  4. 4 The George Institute for Global Health, UNSW Sydney, Camperdown, New South Wales, Australia
  5. 5 The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
  6. 6 Centre for Big Data Research in Health, UNSW Sydney, Kensington, New South Wales, Australia
  7. 7 Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, Australia
  8. 8 Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
  9. 9 School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Annelies L Robijn, National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, New South Wales, Australia; a.robijn{at}unsw.edu.au

Abstract

Objective To determine the comparative effectiveness of postdischarge use of varenicline versus prescription nicotine replacement therapy (NRT) patches for the prevention of recurrent cardiovascular events and mortality and whether this association differs by sex.

Methods Our cohort study used routinely collected hospital, pharmaceutical dispensing and mortality data for residents of New South Wales, Australia. We included patients hospitalised for a major cardiovascular event or procedure 2011–2017, who were dispensed varenicline or prescription NRT patches within 90day postdischarge. Exposure was defined using an approach analogous to intention to treat. Using inverse probability of treatment weighting with propensity scores to account for confounding, we estimated adjusted HRs for major cardiovascular events (MACEs), overall and by sex. We fitted an additional model with a sex–treatment interaction term to determine if treatment effects differed between males and females.

Results Our cohort of 844 varenicline users (72% male, 75% <65 years) and 2446 prescription NRT patch users (67% male, 65% <65 years) were followed for a median of 2.93 years and 2.34 years, respectively. After weighting, there was no difference in risk of MACE for varenicline relative to prescription NRT patches (aHR 0.99, 95% CI 0.82 to 1.19). We found no difference (interaction p=0.098) between males (aHR 0.92, 95% CI 0.73 to 1.16) and females (aHR 1.30, 95% CI 0.92 to 1.84), although the effect among females deviated from the null.

Conclusion We found no difference between varenicline and prescription NRT patches in the risk of recurrent MACE. These results should be considered when determining the most appropriate choice of smoking cessation pharmacotherapy.

  • smoking
  • acute coronary syndrome
  • stroke
  • heart failure

Data availability statement

Data are available on reasonable request. The data underlying this article cannot be shared publicly due to the agreements and terms under current ethics approvals. The data will be shared on reasonable request to the corresponding author.

https://doi.org/10.1136/heartjnl-2022-322170

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    Data availability statement

    Data are available on reasonable request. The data underlying this article cannot be shared publicly due to the agreements and terms under current ethics approvals. The data will be shared on reasonable request to the corresponding author.

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    Footnotes

    • MOF and AH are joint senior authors.

    • Twitter @clara_chow

    • MOF and AH contributed equally.

    • Contributors ALR, KBF, MOF and AH contributed to the conception and design of the study. MW, BH, LJ and AH were involved in data acquisition. ALR conducted the statistical analysis. ALR, MOF and AH drafted the manuscript. ALR was responsible for the overall content as the guarantor. All authors contributed to the interpretation of study data, critical review and revision and agree to be accountable for all aspects of work ensuring integrity and accuracy.

    • Funding This work was supported by a National Health and Medical Research Council (NHMRC) Project grant (APP1147430) for the data linkage, with other aspects of the project funded by AH’s NSW Health Early-Mid Career Fellowship. KBF is supported by a senior salary support awards from the Fonds de recherche du Québec—Santé (Quebec Foundation for Research—Health) and a William Dawson Scholar award from McGill University. MW is supported by NHMRC Investigator and Program Grants. MOF is supported by the NHMRC Early Career Fellowship (APP1139133) and a National Heart Foundation of Australia Future Leader Fellowship (#105609). AH is supported by the National Drug and Alcohol Research Centre, UNSW Sydney, which receives funding from the Australian Government Department of Health under the Drug and Alcohol Program. AH also receives support from the NHMRC Centre of Research Excellence in Medicines Intelligence (GNT1196900).

    • Competing interests MW is consultant to Amgen, Kyowa Kirin and Freeline.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.