When the Cure is Worse than the Disease

5 07 2011

Smoking cigarettes is bad for your cardiovascular health; no questions, no arguments. Now however it seems as if the potential cure might be as bad-or worse-than the disease. Chantix (varenicline) has been very helpful in helping quit smoking. Quitting smoking after a cardiovascular event can reduce your risk of another event by almost 50%; even if you do nothing else. However, as with all powerful drugs there is the potential for The Law of Unintended Consequences. In a recent study published in The Canadian Medical Association Journal[i], it was shown that a very small, but statistically significant increase in cardiovascular events (heart attack or stroke) was present in those taking the drug versus those who did not. The event rate was 1.06% for those taking Chantix and 0.82% for those not (placebo).  While a very small percentage increase, when you estimate about 7 million people taking Chantix that translates into almost 63,000 cardiovascular events. That’s a lot in term of absolute numbers. The take home message here:

  • The absolute risk increase is less than 1%
  • The event rate is low in both groups
  • About 50% of smokers will die from a smoking related illness
  • Chantix is very effective in helping people quit smoking and is only taken for several months
  • There is potential bias in the analysis due to a much higher loss of follow up in the placebo arm

So perhaps the cure is not worse than the disease, but it as with all powerful tools there is a risk. Some good advice is to use any method that helps you quit. The best advice-Don’t start.



[i] (Singh, Loke, Spangler, & Furberg, 2011)




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