What is the effect of nicotine (nicotine replacement therapy) gum on the heart?

From the Guidelines

Nicotine replacement therapy (NRT) gum has a negative effect on the heart, as it can cause an increase in blood pressure, heart rate, and a narrowing of the arteries, which can lead to a heart attack 1.

Key Points

• Nicotine, the main addictive substance in tobacco products, poses risks to the cardiovascular system, including increased blood pressure and heart rate 1.
• Nicotine may also contribute to the hardening of the arterial walls, which can lead to a heart attack 1.
• However, a meta-analysis of safety data from clinical studies with NRT found no evidence of an increased risk of cardiac events associated with NRT treatment, including nicotine gum 1.
• Common adverse effects associated with nicotine gum include jaw fatigue and soreness, hiccupping, burping, and nausea, but not typically serious cardiac events 1.
• It is essential to weigh the potential benefits of NRT gum for smoking cessation against the potential cardiovascular risks, particularly in patients with pre-existing cardiac disease.
• Overall, while nicotine gum may have some negative effects on the heart, the available evidence suggests that it does not significantly increase the risk of cardiac events in most patients 1.

From the FDA Drug Label

Ask a doctor before use if you have ... heart disease, recent heart attack, or irregular heartbeat. Nicotine can increase your heart rate. high blood pressure not controlled with medication. Nicotine can increase blood pressure. Stop use and ask a doctor if ... irregular heartbeat or palpitations occur you get symptoms of nicotine overdose such as ... rapid heartbeat

• Nicotine replacement therapy can have the following effects on the heart:
  • Increase heart rate
  • Increase blood pressure
  • Possibly cause irregular heartbeat or palpitations
  • Possibly cause rapid heartbeat as a symptom of nicotine overdose The use of nicotine gum is advised against or should be used with caution in patients with heart disease, recent heart attack, or irregular heartbeat 2, and patients should stop use and ask a doctor if irregular heartbeat or palpitations occur 2

From the Research

Effect of Nicotine Replacement Therapy Gum on the Heart

• The use of nicotine replacement therapy (NRT) gum has been studied in relation to its effects on the heart, with some studies suggesting that it may contribute to cardiovascular disease due to hemodynamic consequences of sympathetic neural stimulation and systemic catecholamine release 3.
• However, the doses of nicotine obtained by regular cigarette smoking generally exceed those delivered by NRTs, and the cardiovascular effects of nicotine are more intense when delivered rapidly by cigarette smoking than by the slower delivery of transdermal nicotine or nicotine gum 3.
• Clinical trials of NRT in patients with underlying, stable coronary disease suggest that nicotine does not increase cardiovascular risk, and the risks of NRT are no more than those of cigarette smoking 3.
• A meta-analysis of 21 randomized, placebo-controlled trials found that NRT was associated with an increased risk of cardiac disorders, particularly palpitations, but rarely serious cardiac disorders, even in individuals with a cardiovascular history 4.
• The study also found that among patients at high cardiovascular risk, 1.2% experienced a serious cardiovascular event, with no statistically significant difference versus placebo 4.

Comparison with Other Nicotine Replacement Therapies

• The effectiveness of NRT gum has been compared to other forms of NRT, such as transdermal patches, nasal spray, inhalers, and tablets, with all forms being effective in achieving abstinence from cigarettes 5, 6.
• The odds ratios for the different forms of NRT were 1.63 for gum, 1.73 for patches, 2.27 for nasal spray, 2.08 for inhaled nicotine, and 1.73 for nicotine sublingual tablet 5, 6.
• There is weak evidence that combinations of forms of NRT are more effective, and higher doses of nicotine patch may produce small increases in quit rates 5, 6.

Safety and Efficacy

• The safety and efficacy of NRT gum have been established, with the risks of NRT being small and substantially outweighed by the potential benefits of smoking cessation 3, 7.
• NRT gum is a reasonable choice for smoking cessation, especially when used in conjunction with other forms of support and therapy 4, 5, 6.