Cardiology

Antidepressants for quitting smoking

For someone who has just had a heart attack, the need to quit smoking becomes very important. Now, a group of researchers wants to find the best way to help those particular smokers, the ones who have had a major scare and need to make sure not to pick up that pack of cigarettes.

A major research project has gathered a cohort of 1,500 smokers from Quebec, Ontario and British Columbia, who have experienced acute coronary syndrome (ACS), an umbrella term for damage to heart tissue following an attack. In the year-and-a-half-long study that began this spring, half the subjects have begun receiving the smoking cessation drug, buproprion (known by the brand name Zyban), while the other half is being given a placebo. The $1.4 million study will try and gauge the effectiveness of the treatment and confirm the assumption that spending money on a smoking-cessation drug will save lives and be a good use of health-cost dollars.

The ZESCA study (Zyban as an Effective Smoking Cessation Aid) brings together more than two dozen centres and is being led by the Jewish General Hospital’s Mark Eisenberg. Among the researchers are Université de Montréal’s Gilles Paradis and Stéphane Rinfret.

Rinfret is conducting a sub-study of the ZESCA trials. He will be looking at the cost-effectiveness of Zyban in this context, seeing if the costs of the treatment are worth the savings in life years. “It’s always a trade-off. Should we invest as a society to try and get a better strategy to stop smoking? Is this a good use of our resources?” asked Rinfret. Those in charge of provincial health budgets will be able to put his figures up against studies that look at such things as public education programs or counselling.

The Harvard-trained epidemiologist who works out of Notre Dame Hospital’s Department of Cardiology will be calculating how much it will cost to produce an extra year of life for those subjects. But his calculations will also consider quality of life, as well as the reluctance of patients, who already go home from the hospital with a plethora of pills.

Rinfret feels there has been too little studied on the effectiveness of Zyban, originally created as an anti-depressant under the name Wellbutrin. While studies have shown its effectiveness as an aid to stop smoking, there has never been a study to look at its effectiveness for post ACS patients.

For Rinfret, the vulnerable state of the heart-attack patient is an important factor in looking at the effectiveness of this drug. “There are many withdrawal symptoms in smoking cessation, including nervousness, a lack of sleep and depression. This drug seems to be able to reduce those symptoms.”

The researchers have made sure to stay completely independent from the pharmaceutical industry, with all funding coming from the Canadian Institutes of Health Research, the federal granting agency.