用伐尼克兰戒烟是否会恶化血管内皮功能？
Does smoking cessation with varenicline worsen vascular endothelial function?
机构信息
Department of Internal Medicine, International University of Health and Welfare Shioya Hospital, Tochigi, Japan.
出版信息
BMJ Open. 2013 Jun 21;3(6):e003052. doi: 10.1136/bmjopen-2013-003052.
OBJECTIVES
A meta-analysis suggested that the use of varenicline, which is a partial agonist of nicotinic acetylcholine receptors and is effective in smoking cessation, increases the risk of cardiovascular events within 52 weeks of starting treatment. Defining these events as occurring during drug treatment (usually for 12 weeks) or within 30 days of discontinuation, another meta-analysis showed that the risk was statistically insignificant. In the present study, we aimed to clarify the effect of varenicline-assisted smoking cessation on vascular endothelial function assessed by flow-mediated vasodilation (FMD).
DESIGN
Before-after and time-series.
SETTING
Tochigi Prefecture, Japan.
PARTICIPANTS
Data of 85 participants who visited nicotine-dependent outpatient services were reviewed. FMD was repeatedly measured in 33 of the 85 participants.
INCLUSION CRITERIA
20 years and older, Brinkman index ≥200, Tobacco Dependence Screener ≥5 and stated motivation to quit smoking.
INTERVENTIONS
Each participant was treated with varenicline titrated up to 1.0 mg twice daily (for 12 weeks in total).
PRIMARY AND SECONDARY OUTCOME MEASURES
Participants were evaluated by FMD prior to, and 3 months after, complete smoking cessation. Follow-up FMD measurements were carried out every 3 months if possible. Changes in FMD during varenicline use were also evaluated.
RESULTS
FMD was significantly increased from 4.0±1.8% to 5.5±2.2% (p<0.01, n=22) 3 months after complete cessation. Although the timecourse of FMD in most of the cases showed an increase with fluctuations, there was an exceptional case where FMD decreased over the 9 months following complete cessation. Although statistically insignificant, FMD also increased during varenicline use (from 3.7±2.7% to 4.3±2.8%, n=11).
CONCLUSIONS
Our observations suggest that in ceasing smokers, varenicline and smoking cessation do not lead to a worsening of the vascular endothelial function.
TRIAL REGISTRATION
FK-79 (International University of Health and Welfare).
目的
一项荟萃分析表明，使用瓦伦尼克林（一种烟碱型乙酰胆碱受体部分激动剂，对戒烟有效）会增加治疗开始后 52 周内心血管事件的风险。通过将这些事件定义为在药物治疗期间（通常为 12 周）或停药后 30 天内发生，另一项荟萃分析表明，这种风险在统计学上并不显著。在本研究中，我们旨在通过血流介导的血管扩张（FMD）来明确瓦伦尼克林辅助戒烟对血管内皮功能的影响。
设计
前后对照和时间序列研究。
地点
日本栃木县。
参与者
回顾了 85 名就诊于尼古丁依赖门诊的参与者的数据。其中 33 名参与者的 FMD 被重复测量。
纳入标准
年龄≥20 岁，布利克曼指数≥200，烟草依赖筛查器≥5，且表示有戒烟意愿。
干预措施
每位参与者接受瓦伦尼克林滴定治疗，剂量为每日 2 次，每次 1.0 毫克（总疗程为 12 周）。
主要和次要观察指标
在完全戒烟前和戒烟后 3 个月，参与者接受 FMD 评估。如果可能，每 3 个月进行一次随访 FMD 测量。还评估了瓦伦尼克林使用期间 FMD 的变化。
结果
在 22 名参与者中，FMD 从 4.0±1.8%显著增加到 5.5±2.2%（p<0.01）。在大多数情况下，FMD 的时间进程显示出波动的增加，但有一个例外，即完全戒烟后 9 个月内 FMD 下降。虽然在统计学上无显著意义，但 FMD 在瓦伦尼克林使用期间也有所增加（从 3.7±2.7%增加到 4.3±2.8%，n=11）。
结论
我们的观察结果表明，在戒烟者中，瓦伦尼克林和戒烟不会导致血管内皮功能恶化。
试验注册
FK-79（国际健康福利大学）。
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