RESUMEN
Tobacco use is one of the major public health concerns and it is the most preventable cause of morbidity and mortality worldwide. Smoking cessation reduces subsequent cardiovascular events and mortality. Smoking is a real chronic disorder characterized by the development of an addiction status mainly due to nicotine. This condition makes the smokers generally unable to quit smoking without help. Different strategies are available to treat smoking dependence that include both non-pharmacological (behavioral counselling) and pharmacological therapies. Currently, it is well accepted that smoking cessation drugs are effective and safe in real-world settings. Nicotine replacement therapy (NRT), varenicline, bupropion and cytisine are the main pharmacological strategies available for smoking cessation. Their efficacy and safety have been proved even in patients with chronic cardiovascular disease. Each of these drugs has peculiar characteristics and the clinician should customize the smoking cessation strategy based on currently available scientific evidence and patient's preference, paying particular attention to those patients having specific cardiovascular and psychiatric comorbidities. The present document aims to summarize the current viable pharmacological strategies for smoking cessation, also discussing the controversial issue regarding the use of alternative tobacco products, in order to provide useful practical indications to all physicians, mainly to those involved in cardiovascular prevention.
Asunto(s)
Alcaloides/uso terapéutico , Bupropión/uso terapéutico , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Cese del Hábito de Fumar , Fumar/efectos adversos , Tabaquismo/tratamiento farmacológico , Vareniclina/uso terapéutico , Alcaloides/efectos adversos , Azocinas/efectos adversos , Azocinas/uso terapéutico , Bupropión/efectos adversos , Toma de Decisiones Clínicas , Sistemas Electrónicos de Liberación de Nicotina , Humanos , Quinolizinas/efectos adversos , Quinolizinas/uso terapéutico , Recurrencia , Factores de Riesgo , Agentes para el Cese del Hábito de Fumar/efectos adversos , Dispositivos para Dejar de Fumar Tabaco , Tabaquismo/diagnóstico , Tabaquismo/fisiopatología , Tabaquismo/psicología , Resultado del Tratamiento , Vareniclina/efectos adversosRESUMEN
Cardiovascular (CV) comorbidities in patients with chronic obstructive pulmonary disease (COPD) are associated with increased morbidity and mortality, especially in old and very old subjects. The question if long-acting beta-agonist and long-acting muscarinic antagonist could be associated with the increased prevalence of CV-related adverse effects has puzzled, particularly in the past, specialists involved in the management of respiratory diseases. The safety of these compounds has scarcely been tested in patients aged ≥ 65 years with CV comorbidities, since randomized controlled trials rarely include this subpopulation. However, the fixed combination indacaterol/glycopyrronium has shown a favorable CV safety profile in both healthy volunteers and COPD patients. Thus, we aimed to assess the CV safety pro