1. Cardiac Patient

2. The most important modifiable risk factor for
cardiovascular disease

3. Tobacco Smoke causes harm
1.Contribute to a proinflammatory state
2.Damage endothelial surfaces
3.Induce endothelial dysfunction
4.Distort the lipid profile and oxidize lipoproteins
5.Facilitate platelet aggregation and activation
6.Elevate fibrinogen levels
7.Potentiate the development of atheroma
8.Contribute to plaque “instability”
9.Produce elevated levels of carboxyhemoglobin and impair oxygen
transport

4. MORTALITY RISK REDUCTION IN CAD
Smoking Cessation 36%
Statin Therapy 29%
β-Blocker Therapy 23%
ACE-I Therapy 23%
ASA Therapy 15%

5. UNIVERSITY OF OTTAWA HEART INSTITUTE STANDARD’ ORDERS
FOR NICOTINE REPLACEMENT
Standard Orders for Nicotine Replacement Therapy (NRT)
20 Cigarettes per day 21-mg NRT Patch +/× Short Acting NRT
30 Cigarettes per day 21 + 7-mg NRT Patches +/× Short Acting NRT
40 Cigarettes per day 2 × 21-mg NRT Patches +/− Short Acting NRT
Standard Orders for Bupropion
Day 1 to 3 150 mg qd
Day 4 to Week 12 150 mg bid
Standard Orders for Varenicline
Day 1 to 3 0.5 mg qd
Day 4 to 7 0.5 mg bid
Week 2 to 12 0.5-1.0 mg bid (initial course may be repeated)

6. Have a nice time