José L Ferreiro1, Deepak L Bhatt2, Masafumi Ueno3, Deborah Bauer4, Dominick J Angiolillo5. 1. University of Florida College of Medicine-Jacksonville, Jacksonville, Florida; Heart Diseases Institute, Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. 2. VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts. 3. University of Florida College of Medicine-Jacksonville, Jacksonville, Florida. 4. Department of Biostatistics, Sanofi, Bridgewater, New Jersey. 5. University of Florida College of Medicine-Jacksonville, Jacksonville, Florida. Electronic address: dominick.angiolillo@jax.ufl.edu.
Abstract
OBJECTIVES: The goal of this study was to investigate the differential efficacy of clopidogrel or aspirin monotherapy according to smoking status in patients with atherosclerotic vascular disease. BACKGROUND: Smoking enhances clopidogrel-induced platelet inhibition, which may explain the higher relative benefit among smokers observed in trials evaluating dual antiplatelet therapy. Whether smoking has an impact on clinical outcomes in patients requiring a single antiplatelet agent remains unknown. METHODS: This was a post-hoc analysis of the CAPRIE (Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events) trial that compared clopidogrel and aspirin monotherapy in patients (N = 19,184) with atherosclerotic vascular disease. RESULTS: Current smokers (n = 5,688) had an increased risk of ischemic events compared with never smokers (n = 4,135; hazard ratio [HR]: 1.24 [95% confidence interval (CI): 1.08 to 1.42]) and ex-smokers (n = 9,381; HR: 1.32 [95% CI: 1.18 to 1.47]) (p < 0.001). Clopidogrel was associated with a reduction in ischemic events among current smokers (8.3% vs. 10.8%; HR: 0.76 [95% CI: 0.64 to 0.90]), whereas no benefit over aspirin was seen in the combined group of ex-smokers/never-smoked patients (10.4% vs. 10.6%; HR: 0.99 [95% CI: 0.89 to 1.10]; p = 0.01 for interaction). Among current smokers, clopidogrel also reduced myocardial infarction, vascular death, and death from any cause compared with aspirin. No interaction between smoking status and study treatment was observed for bleeding events. CONCLUSIONS: In a post-hoc analysis of the CAPRIE population, current smokers appeared to have enhanced benefit with clopidogrel therapy for secondary prevention compared with aspirin. These results should be considered hypothesis generating for future prospective studies assessing the impact of specific platelet-inhibiting strategies according to smoking status.
RCT Entities:
OBJECTIVES: The goal of this study was to investigate the differential efficacy of clopidogrel or aspirin monotherapy according to smoking status in patients with atherosclerotic vascular disease. BACKGROUND: Smoking enhances clopidogrel-induced platelet inhibition, which may explain the higher relative benefit among smokers observed in trials evaluating dual antiplatelet therapy. Whether smoking has an impact on clinical outcomes in patients requiring a single antiplatelet agent remains unknown. METHODS: This was a post-hoc analysis of the CAPRIE (Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events) trial that compared clopidogrel and aspirin monotherapy in patients (N = 19,184) with atherosclerotic vascular disease. RESULTS: Current smokers (n = 5,688) had an increased risk of ischemic events compared with never smokers (n = 4,135; hazard ratio [HR]: 1.24 [95% confidence interval (CI): 1.08 to 1.42]) and ex-smokers (n = 9,381; HR: 1.32 [95% CI: 1.18 to 1.47]) (p < 0.001). Clopidogrel was associated with a reduction in ischemic events among current smokers (8.3% vs. 10.8%; HR: 0.76 [95% CI: 0.64 to 0.90]), whereas no benefit over aspirin was seen in the combined group of ex-smokers/never-smoked patients (10.4% vs. 10.6%; HR: 0.99 [95% CI: 0.89 to 1.10]; p = 0.01 for interaction). Among current smokers, clopidogrel also reduced myocardial infarction, vascular death, and death from any cause compared with aspirin. No interaction between smoking status and study treatment was observed for bleeding events. CONCLUSIONS: In a post-hoc analysis of the CAPRIE population, current smokers appeared to have enhanced benefit with clopidogrel therapy for secondary prevention compared with aspirin. These results should be considered hypothesis generating for future prospective studies assessing the impact of specific platelet-inhibiting strategies according to smoking status.
Authors: Jung Rae Cho; Bhaloo Desai; Michael J Haas; Fabiana Rollini; Francesco Franchi; Ana Muñiz-Lozano; Antonio Tello-Montoliu; Elisabetta Ferrante; Luis A Guzman; Theodore A Bass; Dominick J Angiolillo Journal: J Cardiovasc Transl Res Date: 2013-12-20 Impact factor: 4.132
Authors: Fabiana Rollini; Francesco Franchi; Jung Rae Cho; Christopher Degroat; Mona Bhatti; Elisabetta Ferrante; Ronakkumar Patel; Andrew Darlington; Antonio Tello-Montoliu; Bhaloo Desai; Joséluis Ferreiro; Ana Muniz-Lozano; Martin M Zenni; Luis A Guzman; Theodore A Bass; Dominick J Angiolillo Journal: J Cardiovasc Transl Res Date: 2014-01-07 Impact factor: 4.132
Authors: Tanush Gupta; Dhaval Kolte; Sahil Khera; Prakash Harikrishnan; Marjan Mujib; Wilbert S Aronow; Diwakar Jain; Ali Ahmed; Howard A Cooper; William H Frishman; Deepak L Bhatt; Gregg C Fonarow; Julio A Panza Journal: J Am Heart Assoc Date: 2016-04-22 Impact factor: 5.501
Authors: Matthias Bossard; Christopher B Granger; Jean-Francois Tanguay; Gilles Montalescot; David P Faxon; Sanjit S Jolly; Petr Widimsky; Kari Niemela; Philippe Gabriel Steg; Madhu K Natarajan; Peggy Gao; Keith A A Fox; Salim Yusuf; Shamir R Mehta Journal: J Am Heart Assoc Date: 2017-11-03 Impact factor: 5.501