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Review
. 2023 Mar 21:10:1111673.
doi: 10.3389/fcvm.2023.1111673. eCollection 2023.

Study title: A systematic review of RCTs to examine the risk of adverse cardiovascular events with nicotine use

Mimi M Kim  1 , Isabella Steffensen  2 , Red Thaddeus D Miguel  2 , Tanja Babic  2 , Aubrey D Johnson  1 , Julien Carlone  2 , Ryan Potts  3 , Christopher S Junker  1
Affiliations
Review

Study title: A systematic review of RCTs to examine the risk of adverse cardiovascular events with nicotine use

Mimi M Kim et al. Front Cardiovasc Med. .

Abstract

Associations between cigarette smoking and increased risk of cardiovascular disease are well established. However, it is unclear whether the association is mediated by exposure to nicotine and/or to other constituents in cigarette smoke. The objective of this systematic review and meta-analysis of randomized control trials (RCTs) was to identify any potential associations between exposure to nicotine and the risk of clinically diagnosed adverse cardiovascular events in adult current users and nonusers of tobacco products. Among 1,996 results, 42 studies, comparing nicotine and non-nicotine groups, were included and were both qualitatively and quantitatively synthesized across the outcomes of arrhythmia, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death. The majority of studies evaluating nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death reported no events that occurred in either the nicotine or non-nicotine control groups. Among the studies that reported events, rates of adverse events were similarly low between both groups. Consistent with findings from previous systematic reviews and meta-analyses, pooled data showed that rates for arrhythmia, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death were not significantly different between nicotine and non-nicotine groups. The overall quality of the body of evidence for each of the four outcomes of interest was graded as "moderate," limited only by the imprecision of results. The findings of this systematic review and meta-analysis indicate that, with moderate certainty, there are no significant associations between the use of nicotine and the risk of clinically diagnosed adverse cardiovascular events-specifically, arrhythmia, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death.

Keywords: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis); adverse event (AE); cardiovascular; nicotine; systematic review and meta-analysis.

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Conflict of interest statement

MK and CJ serve as full-time employee of RAI Services Company, a wholly owned subsidiary of Reynolds American Inc. RP is a full-time employee of BAT (Investments) Limited. All study activities were executed by providers external to RAI Services Company (Thera-Business), who were financially compensated for services according to contractual terms with RAI Services Company. RAI Services Company is a wholly owned subsidiary of Reynolds American Inc., whose operating companies manufacture and market tobacco products. The conception, analysis, and writing for this manuscript was a collaboration between Thera-Business and RAI Services Company.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Included studies by publication year.
Figure 3
Figure 3
Study site of included studies.
Figure 4
Figure 4
Forest plot, meta-analysis for arrhythmia (overall).
Figure 5
Figure 5
Forest plot, meta-analysis for nonfatal myocardial infarction.
Figure 6
Figure 6
Forest plot, meta-analysis for nonfatal stroke.
Figure 7
Figure 7
Forest plot, meta-analysis for cardiovascular death.
See this image and copyright information in PMC

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