Cardiovascular effects of nicotine gum and cigarettes assessed by ECG and echocardiography.

Cigarette smoking is one of the most firmly established risk factors for coronary heart disease (Kannel 1981). This risk can be dramatically reduced by discontinuation of cigarette smoking (Doll and Peto 1976; Hammond and Garfinkle 1969; Kannel 1981). Unfortunately, smoking cessation programs have low long-term success rates (Evans and Lane 1980; Raw 1978; Schwartz 1979). Several investigators attribute the maintenance of smoking behavior to a dependence upon nicotine (Gritz 1980; Jarvik 1970; Russell 1980). Nicotine induced withdrawal symptoms and nicotine seeking may account for cessation difficulty and high relapse rates. Nicotine chewing gum was introduced as a means of treating the pharmacological dependence during cessation of smoking (Ferno et al. 1973). The 4 mg dose results in blood levels of nicotine similar to a cigarette although without the “bolus” effect (see Russell and Jarvis in this volume). The 2 mg dose results in even lower blood levels. The purpose of using nicotine gum is to prevent abrupt withdrawal from nicotine and consequent symptoms and craving while supplying a substitute oral activity. Several recent studies attest to its efficacy in the alleviation of withdrawal (Hughes et al. 1984; Schneider et al. 1984; West 1984). Enhanced success rates in smoking cessation have been demonstrated in a number of recent placebo-controlled trials (Fagerstrom 1982: Hjalmarson 1984; Jarvis et al. 1982; Killen et al. 1984; Schneider et al. 1983). Since its introduction in the United States in 1984, this preparation is now widely available by prescription for the treatment of smoking dependence.