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European Heart Journal 2000 21(6):438-445; doi:10.1053/euhj.1999.1949
Copyright © 2000 by the European Society of Cardiology.
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Working Group Report

Diagnosis and treatment of nicotine dependence with emphasis on nicotine replacement therapy. A status report

D Balfoura, N Benowitzb,c, K Fagerströmd, M Kunzee and U Keilf,f1

a Department of Pharmacology and Neuroscience, University of Dundee Medical School, Dundee, Scotland, U.K.
b Clinical Pharmacology Unit of the Medical Service, San Francisco General Hospital Medical Center, San Francisco, U.S.A.
c Departments of Medicine, Psychiatry and Pharmacy, University of California, San Francisco, U.S.A.
d Fagerström Consulting, Berga alle 1, S252 25, Helsingborg, Sweden
e Institute of Social Medicine, University of Vienna, Vienna, Austria
f Institute of Epidemiology and Social Medicine, University of Muenster, Germany

revised September 13, 1999; accepted September 15, 1999

Abstract

Tobacco use is a global health care problem. Repetitive exposure to nicotine produces neuroadaptation resulting in nicotine dependence. Cigarette smoking is particularly addictive due to the repeated delivery of bolus doses of nicotine to the bloodstream. Although compulsive tobacco use is sustained by nicotine addiction, it is the toxic combustion products in tobacco smoke such as carbon monoxide and oxidant gases that adversely affect the cardiovascular system. Smoking cessation produces significant health benefits and is a very cost-effective intervention. Evidence that nicotine is the addictive component of tobacco provides the rationale for using nicotine replacement therapy to aid cessation. Nicotine replacement therapy doubles successful smoking cessation rates and evidence-based guidelines for the treatment of tobacco addiction recommend routine use of nicotine replacement therapy, particularly in heavily dependent smokers. Success rates of up to 40% can be achieved in specialist clinics. Despite early concerns regarding the safety of nicotine replacement therapy in smokers with heart disease, it is now clear that the health risks of using nicotine replacement therapy to assist such patients to stop, or significantly reduce, smoking far outweigh any treatment-related risks.

Key Words: Tobacco dependence, smoking cessation, nicotine replacement therapy

f1 Correspondence: Ulrich Keil, Institute of Epidemiology and Social Medicine, Medical Faculty, University of Muenster, Domagkstrasse 3, 48129 Muenster, Germany.

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