Smoking is a recognized risk factor for acute coronary syndrome (ACS), but more than two-thirds of patients continue to smoke after being hospitalized for an ACS. Varenicline is an α4β2 nicotinic acetylcholine receptor partial agonist that reduces cravings and withdrawal symptoms during smoking abstinence. In the multicentre, randomized EVITA trial, 302 patients hospitalized with ACS and who smoked ≥10 cigarettes per day were randomly assigned to receive varenicline or placebo for 12 weeks. Patients who received varenicline were significantly more likely to abstain from smoking or to reduce their cigarette consumption than those who received placebo. “These findings suggest that varenicline, initiated in-hospital following ACS, and in conjunction with low-intensity counselling, is efficacious for smoking cessation,” conclude the investigators. “Future studies are needed to establish safety in these patients.”