At this time, judicious use and dosing of nicotine replacement therapy are recommended for patients admitted to hospital with an acute cardiovascular event. In addition to nicotine replacement medications, bupropion and varenicline can be effective adjuncts to smoking cessa- tion strategies, and their use has been supported by the US Public Health Service.305 Bupropion is generally well toler- ated and has been shown to be safe to use in the immediate period after MI.310,311 Among 629 patients with cardiovas- cular disease, a 7-week treatment with bupropion resulted in twice as many smokers quitting at 1 year compared with Varenicline has also been shown to be effective in reducing rates of smoking.313,314 In a randomized, placebo- controlled trial of 714 smokers with stable cardiovascular disease, varenicline was effective at reducing rates of smok- Based on data from this trial, however, the US Food and Drug Administration issued an advisory that varenicline may increase the risk of adverse cardiovascular events on the basis of statistically nonsignificant increases in the rates of nonfatal MI, coronary revascularization, and new peripheral vascular disease in this trial population.315 Although the car- diovascular risk profile of varenicline remains unsettled, the long-term benefits of smoking cessation far outweigh any potential adverse effects with varenicline. Therefore, it should still be carefully considered as a possible medication to assist in smoking cessation for patients with cardiovascular disease. During the process of smoking cessation, patients may face many potential obstacles to achieving their goal. They may struggle with high dependence on nicotine, severe withdrawal problems, low self-confidence, poor social support, weight gain, comorbid psychiatric illnesses, and suboptimal use of Addressing each of these issues as they arise is critical to achieving smoking cessation. 