Smoking: A Deadly Pleasant Habit—Is There a Way Out?

It was not until 1958 that the first major epidemiologic study demonstrated a strong correlation between smoking and cardiovascular disease. Although not providing definitive evidence that tobacco smoke was responsible for the increased coronary risk, it prompted the first anti-smoking measures by the US Surgeon General in his 1964 report. Smoking is a highly addictive (biological and psychological) habit. The severity of withdrawal symptoms that patients find distressing can be reduced by nicotine replacement therapy. Bupropion SR was the first nonnicotine medication shown to be effective for smoking cessation. Its possible mechanisms of action include blockade of neuronal reuptake of dopamine and norepinephrine and blockade of nicotinic acetylcholinergic receptors. Varenicline, a nicotine receptor partial agonist, is the most recently developed nonnicotine preparation. The odds of smoking cessation after 12 weeks of 1 mg twice-daily varenicline treatment was approximately twice that achieved with 150 mg twice-daily bupropion and nearly 4-fold greater than with placebo.