September 19th, 2013
Clopidogrel’s Benefits Seen Mainly in Smokers
Nicholas Downing, MD
Clopidogrel appears to offer more protection against cardiovascular events among smokers than nonsmokers, according to a systematic review in BMJ.
Researchers examined data from six randomized trials comparing clopidogrel (alone or with aspirin) with control treatments (namely, aspirin alone or lower-dose clopidogrel plus aspirin). Nearly 75,000 patients with established cardiovascular disease, 30% of whom were smokers, were included.
Among smokers, clopidogrel was associated with a 25% reduction in the composite outcome of cardiovascular death, MI, or stroke; however, among nonsmokers, it conferred only an 8% reduction. (In a separate analysis, they also found that prasugrel or ticagrelor “seemed to be more efficacious” than clopidogrel in smokers and “marginally more efficacious” in nonsmokers.)
The researchers conclude: “Different risk-benefit considerations might be required for smokers and nonsmokers.”
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