Thienopyridine efficacy and cigarette smoking status
Thienopyridine efficacy and cigarette smoking status
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DOI：
10.1016/j.ahj.2012.12.024
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发表时间：
2013-05-01
影响因子：
4.8
通讯作者：
Gurbel, Paul A.
中科院分区：
文献类型：
--
作者：
Bliden, Kevin P.;Baker, Brian A.;Gurbel, Paul A.
阿司匹林和P2 Y12受体阻滞剂双重抗血小板治疗是降低高危心血管（CV）疾病患者发生缺血性事件风险的既定方案。吸烟是一个重要的心血管危险因素。然而，一些研究者报道了一种“新的”“吸烟者悖论”，根据几项大规模试验，与氯吡格雷治疗的吸烟者的CV事件大幅减少相比，氯吡格雷治疗的非吸烟者的CV事件减少较少或没有。在多项临床结局研究中观察到的这种“吸烟者悖论”也得到了新出现的“真实世界”数据的支持，这些数据也表明氯吡格雷非吸烟者的治疗效果不如接受氯吡格雷治疗的吸烟者。为了支持新的“吸烟者悖论”，药效学研究也表明，吸烟状态影响健康志愿者、急性冠脉综合征患者和经皮冠状动脉介入治疗患者的氯吡格雷反应性。最后，大量（尽管不完全一致）药效学和临床结局数据支持氯吡格雷在非吸烟者中的抗血小板作用低于吸烟者。这种相互作用的临床相关性从未在前瞻性试验中得到证实。本综述的重点是批判性地评估吸烟状态和噻吩并吡啶疗效之间的相互作用。(Am Heart J 2013;165：693-703.）
Dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker is an established regimen to reduce the risk of ischemic event occurrence in patients with high-risk cardiovascular (CV) disease. Cigarette smoking is an important cardiovascular risk factor. However, several investigators have reported what may be termed a "new" "smoker's paradox", whereby clopidogrel-treated nonsmokers appear to have either less or no CV-event reduction when compared to the substantial CV-event reduction in clopidogrel-treated smokers based on several large-scale trials. This "smoker's paradox" observed in multiple clinical outcome studies is also supported by emerging "real-world" data that also suggest clopidogrel nonsmokers do not fare as well as smokers treated with clopidogrel. In support of the new "smoker's paradox", pharmacodynamic studies have also shown that smoking status influences clopidogrel responsiveness in healthy volunteers, acute coronary syndrome patients, and patients treated with percutaneous coronary intervention. Finally, there is a substantial, albeit not entirely consistent, body of pharmacodynamic and clinical outcome data supporting a reduced antiplatelet effect of clopidogrel in non-smokers as compared to smokers. The clinical relevance of this interaction has never been demonstrated in a prospective trial. The focus of this review is to critically evaluate the reported interaction between cigarette smoking status and thienopyridine efficacy. (Am Heart J 2013;165:693-703.)