Nicotine Patches Do Not Increase Risk For First Heart Attack

In the early 1990s, a number of case studies in medical literature linked the use of nicotine patches to heart attacks and called the safety of nicotine replacement therapy into question. While subsequent controlled trials have refuted the link to heart conditions, these lacked the power to describe the cardiovascular effects of nicotine patches in depth. In addition, they did not represent how the general population uses nicotine patches.

“Not everybody uses the patch the same way, especially since they are now available over-the-counter,” said Kimmel. “We sought to examine the problem in terms of ‘real world’ use of the patch, outside of careful control of clinical trials, and whether it had any bearing on heart attacks."

Kimmel and his colleagues interviewed and studied the medical histories of 635 people who had recently suffered from their first heart attack and compared them with 2,990 people who had not had heart attacks to see how using the patch may have contributed to heart attacks. They did not detect any increased risk of heart attack from using the patch, and any potential risk was substantially lower than the risk of a heart attack from smoking alone.

The lack of an association between patch use and heart attack was not due simply to the fact that patch users were not currently smoking. In particular, the researchers found that the risk of heart attack among patch users who did not smoke was not higher than people who were neither smoked nor used the patch. “These results go along with what we understand of the science behind the patch,” explained Kimmel. Although nicotine may cause blood vessels to constrict, nicotine administered through the patch does not seem to raise platelet activity or fibrinogen levels – important indicators for heart attack risk. In addition nicotine levels are typically lower in patch users who abstain from smoking, compared to levels from smoking itself.

According to Kimmel, part of the problem with associating heart attacks and nicotine patches is that patch users have, in general, only recently given up smoking.

“Any damage from smoking has already been done and far outweighs the possible harm from the patch,” said Kimmel. “You shouldn’t let a fear of heart attack prevent you from using the patch – in fact, fear of heart attacks is one of the many things that should inspire you to quit smoking. It is important, of course, to use the patch as directed, to not smoke while you are wearing it, and to check with your doctor first if you already have heart disease or any other concerns.”

This study was supported by a grant from Aventis Pharmaceuticals, Novartis Consumer Health and McNeil Consumer Products.

The University of Pennsylvania Health System is distinguished not only by its historical significance - first hospital (1751), first medical school (1765), first university teaching hospital (1874), first fully integrated academic health system (1993) - but by its position as a major player on the world stage of medicine in the 21st century. Penn ranks second among all American medical schools that receive funds from the National Institutes of Health, perhaps the single most important barometer of research strength.

This project was performed by researchers at the Center for Clinical Epidemiology and Biostatistics at Penn, a world-leader in studying the effects of medications on public health.