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Lawton et al 2021 ACC/AHA/SCAI Coronary Revascularization Guideline

Circulation. 2022;145:e18–e114. DOI: 10.1161/CIR.0000000000001038 January 18, 2022 e75 CLINICAL STATEMENTS AND GUIDELINES

of Cardiovascular Disease”16 and are also applicable to the secondary prevention of patients after coronary artery revascularization.

Recommendation-Specific Supportive Text

1.	 The US Public Health Service’s Clinical Practice Guideline for Smoking Cessation recommends smoking-cessation pharmacotherapy for all smokers attempting to quit.17 The most effective smoking-cessation therapies include both behavioral and pharmacological interventions.1,6 Highquality evidence showed that using a combination of behavioral support and medication increases the chances of successfully quitting for at least 6 months.2,5 Moreover, the chance of success was increased by 70% to 100% compared with just brief advice or support. Among patients with CVD who were motivated to quit smoking, varenicline and bupropion are efficacious for smoking cessation, as are individual and telephone counseling.2,5 Varenicline was the most efficacious of therapies in patients with stable CVD who were motivated to quit smoking.2,5,18,19 In 1 study, abstinence rates in the group of patients treated with varenicline were higher than in those treated with placebo, a result that persisted for 52 weeks.19 Given the uncertainties of the long-term effects of e-cigarettes on health, clinicians have been urged to advise cigarette smokers seeking to quit to use evidence-based, US Food and Drug Administration– approved, safe and effective smoking cessation pharmacotherapies as first-line treatments in preference to e-cigarettes.7

2.	 Studies have shown that when hospitalized tobacco users receive counseling with supportive follow-up for ≥1 month after discharge, smoking cessation rates increase by 37% at 6 to 12 months after discharge.4 Varenicline use for hospitalized smokers with ACS who were motivated to quit significantly increased abstinence versus placebo at 1 year after discharge.20-22 At week 24, using varenicline increased smoking abstinence and reduced cigarette use by ≥50%. There is no evidence that pharmacotherapies (varenicline, bupropion, and nicotine replacement versus placebo) increase the risk of cardiovascular adverse events during or after treatment.19,21,23 The EAGLES (Neuropsychiatric Safety and Efficacy of Varenicline, Bupropion, and Nicotine Patch in Smokers With and Without Psychiatric Disorders) trial showed that pharmacotherapies do not increase the risk of cardiovascular or neuropsychiatric adverse events compared with nicotine patch or placebo in smokers with and without psychiatric disorders.18,23

Figure 8. Traditional and Psychosocial Risk Factors for ASCVD. ASCVD indicates atherosclerotic cardiovascular disease.

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