In a randomized, double-blind, pla- cebo-controlled trial, a 10-week outpatient course of transder- mal nicotine did not increase the rate of cardiovascular events among patients with at least 1 diagnosis of cardiovascular dis- In hospitalized patients, nicotine replacement therapy is commonly used as an effective strategy to manage nicotine but less is known about the routine use of nicotine replacement therapy during an acute cardio- vascular event. In a retrospective analysis of smokers admitted with acute coronary syndromes, transdermal nicotine therapy was not associated with an increased risk of mortality.308 On the other hand, in a retrospective analysis of smokers hospital- ized during CABG, nicotine replacement therapy was asso- ciated with an increased mortality rate after adjustment for Both of these studies were limited by their observational design and specifically by the biases associated with the use of nicotine replacement therapy such as the degree of prior smoking. As a result, prospective studies are needed to determine the safety of using nicotine replace- ment therapy in patients with acute cardiovascular disease. At this time, judicious use and dosing of nicotine replacement therapy are recommended for patients admitted to hospital with an acute cardiovascular event. 