Effectiveness and Safety of Bupropion for Smoking Cessation in Smokers with Cardiovascular Disease: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGJin ¹ , HEZhi-yu ¹ , YANGLin ² , ZHANGJing ¹ ,  YAOYa-li ¹

1. Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou 730000, China;
2. Second Provincial People's Hospital of Gansu, Lanzhou 730000, China;

Corresponding author：

YAOYa-li, Email: yaoyalifs@aliyun.com

Keywords：

Bupropion; Cardiovascular disease; Smoking cessation; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20140051

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the effectiveness and safety of bupropion for smoking cessation in smokers with cardiovascular disease. Methods Databases including The Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, WanFang Data and VIP databases were electronically searched from inception to February 23rd, 2013. Randomized controlled trials (RCTs) on bupropion versus placebo for smoking cessation in smokers with cardiovascular disease were included. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of included studies. Meta-analysis was performed by using RevMan 5.1 software. Results In total, 4 studies involving 1 415 patients were finally included. The results of metaanalyses indicated that, compared with placebo, bupropion significantly increased the point prevalence abstinence rate at 3 months (RR=1.79, 95%CI 1.14 to 2.83, P=0.01). However, the point prevalence abstinence rates at 6 months (RR=1.81, 95%CI 0.77 to 4.24, P=0.18) and 12 months (RR=1.46, 95%CI 0.94 to 2.27, P=0.10), and the continuous abstinence rates at 3 months (RR=1.48, 95%CI 0.89 to 2.47, P=0.13), 6 months (RR=1.41, 95%CI 0.79 to 2.51, P=0.25), and 12 months (RR=1.43, 95%CI 0.93 to 2.17, P=0.10) were similar in the two groups. The use of bupropion did not increase all-cause mortality (RR=1.13, 95%CI 0.49 to 2.56, P=0.78) and the incidence of cardiovascular events (RR=1.25, 95%CI 0.95 to 1.64, P=0.11). Conclusion Bupropion is safe to use in smokers with cardiovascular disease. Although bupropion could increase the point prevalence abstinence rate at 3 months, it is not effective for long-term smoking cessation. Due to the limited quantity and quality of the included studies, more large-scale high-quality RCTs are required to verify the aforementioned conclusion.

Citation： ZHANGJin, HEZhi-yu, YANGLin, ZHANGJing, YAOYa-li. Effectiveness and Safety of Bupropion for Smoking Cessation in Smokers with Cardiovascular Disease: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(3): 292-298. doi: 10.7507/1672-2531.20140051 Copy

1.	Centers for disease control and prevention, US department of health and human services. The health consequences of smoking:A report of the surgeon general. Available at:http://www.Cdc.Gov/tobacco/data_statistics/sgr/sgr_2004/chapters.htm. Accessed at Ferburay 30, 2013.
2.	Critchley J, Capewell S. Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev, 2004(1):CD003041.
3.	Teo KK, Ounpuu S, Hawken S, et al. Tobacco use and risk of myocardial infarction in 52 countries in the interheart study:A casecontrol study. Lancet, 2006, 368(9536):647-658.
4.	Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease:A systematic review. JAMA, 2003, 290(1):86-97.
5.	Smith SC Jr, Allen J, Blair SN, et al. Aha/acc guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease:2006 update:Endorsed by the national heart, lung, and blood institute. Circulation, 2006, 113(19):2363-2372.
6.	Quist-Paulsen P, Gallefoss F. Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease. BMJ, 2003, 327(7426):1254-1257.
7.	Foley KF, DeSanty KP, Kast RE. Bupropion:Pharmacology and therapeutic applications. Expert Rev Neurother, 2006, 6(9):1249-1265.
8.	国效峰, 陈晋东, 赵靖平, 等.盐酸安非他酮缓释片戒除烟瘾的初步临床试验.中国药物依赖性杂志, 2005, 14(6):434-436.
9.	Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med, 1999, 340(9):685-691.
10.	Joseph AM, Fu SS. Safety issues in pharmacotherapy for smoking in patients with cardiovascular disease. Prog Cardiovasc Dis, 2003, 45(6):429-441.
11.	Tonstad S, Farsang C, Klaene G, et al. Bupropion sr for smoking cessation in smokers with cardiovascular disease:A multicentre, randomised study. Eur Heart J, 2003, 24(10):946-955.
12.	Eisenberg MJ, Grandi SM, Gervais A, et al. Bupropion for smoking cessation in patients hospitalized with acute myocardial infarction:A randomized, placebo-controlled trial. J Am Coll Cardiol, 2013, 61(5):524-532.
13.	Planer D, Lev I, Elitzur Y, et al. Bupropion for smoking cessation in patients with acute coronary syndrome. Arch Intern Med, 2011, 171(12):1055-1060.
14.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated march 2011]. The cochrane collaboration, 2011. Available at:www.cochrane-handbook.org. Accessed at Ferburay 30, 2013.
15.	Guyatt GH, Oxman AD, Vist GE, et al. Grade:An emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650):924-926.
16.	Rigotti NA, Thorndike AN, Regan S, et al. Bupropion for smokers hospitalized with acute cardiovascular disease. Am J Med, 2006, 119(12):1080-1087.
17.	Tobacco use and dependence guideline panel. Treating tobacco use and dependence:2008 update. Rockville(md):US department of health and human services; 2008 may. Available at:http://www.Ncbi.Nlm.Nih.Gov/books/nbk63952/.Accessed at Ferburay 30, 2013.
18.	Simon JA, Carmody TP, Hudes ES, et al. Intensive smoking cessation counseling versus minimal counseling among hospitalized smokers treated with transdermal nicotine replacement:A randomized trial. Am J Med, 2003, 114(7):555-562.
19.	The agency for health care policy and research smoking cessation clinical practice guideline. JAMA, 1996, 275(16):1270-1280.

1. Centers for disease control and prevention, US department of health and human services. The health consequences of smoking:A report of the surgeon general. Available at:http://www.Cdc.Gov/tobacco/data_statistics/sgr/sgr_2004/chapters.htm. Accessed at Ferburay 30, 2013.
2. Critchley J, Capewell S. Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev, 2004(1):CD003041.
3. Teo KK, Ounpuu S, Hawken S, et al. Tobacco use and risk of myocardial infarction in 52 countries in the interheart study:A casecontrol study. Lancet, 2006, 368(9536):647-658.
4. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease:A systematic review. JAMA, 2003, 290(1):86-97.
5. Smith SC Jr, Allen J, Blair SN, et al. Aha/acc guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease:2006 update:Endorsed by the national heart, lung, and blood institute. Circulation, 2006, 113(19):2363-2372.
6. Quist-Paulsen P, Gallefoss F. Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease. BMJ, 2003, 327(7426):1254-1257.
7. Foley KF, DeSanty KP, Kast RE. Bupropion:Pharmacology and therapeutic applications. Expert Rev Neurother, 2006, 6(9):1249-1265.
8. 国效峰, 陈晋东, 赵靖平, 等.盐酸安非他酮缓释片戒除烟瘾的初步临床试验.中国药物依赖性杂志, 2005, 14(6):434-436.
9. Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med, 1999, 340(9):685-691.
10. Joseph AM, Fu SS. Safety issues in pharmacotherapy for smoking in patients with cardiovascular disease. Prog Cardiovasc Dis, 2003, 45(6):429-441.
11. Tonstad S, Farsang C, Klaene G, et al. Bupropion sr for smoking cessation in smokers with cardiovascular disease:A multicentre, randomised study. Eur Heart J, 2003, 24(10):946-955.
12. Eisenberg MJ, Grandi SM, Gervais A, et al. Bupropion for smoking cessation in patients hospitalized with acute myocardial infarction:A randomized, placebo-controlled trial. J Am Coll Cardiol, 2013, 61(5):524-532.
13. Planer D, Lev I, Elitzur Y, et al. Bupropion for smoking cessation in patients with acute coronary syndrome. Arch Intern Med, 2011, 171(12):1055-1060.
14. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[updated march 2011]. The cochrane collaboration, 2011. Available at:www.cochrane-handbook.org. Accessed at Ferburay 30, 2013.
15. Guyatt GH, Oxman AD, Vist GE, et al. Grade:An emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650):924-926.
16. Rigotti NA, Thorndike AN, Regan S, et al. Bupropion for smokers hospitalized with acute cardiovascular disease. Am J Med, 2006, 119(12):1080-1087.
17. Tobacco use and dependence guideline panel. Treating tobacco use and dependence:2008 update. Rockville(md):US department of health and human services; 2008 may. Available at:http://www.Ncbi.Nlm.Nih.Gov/books/nbk63952/.Accessed at Ferburay 30, 2013.
18. Simon JA, Carmody TP, Hudes ES, et al. Intensive smoking cessation counseling versus minimal counseling among hospitalized smokers treated with transdermal nicotine replacement:A randomized trial. Am J Med, 2003, 114(7):555-562.
19. The agency for health care policy and research smoking cessation clinical practice guideline. JAMA, 1996, 275(16):1270-1280.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Bupropion for Smoking Cessation in Smokers with Cardiovascular Disease: A Meta-Analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content