Smoking, Clopidogrel, and Mortality in Patients With Established Cardiovascular Disease
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- Jeffrey S. Berger
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
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- Deepak L. Bhatt
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
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- Steven R. Steinhubl
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
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- Mingyuan Shao
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
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- P. Gabriel Steg
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
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- Gilles Montalescot
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
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- Werner Hacke
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
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- Keith A. Fox
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
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- A. Michael Lincoff
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
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- Eric J. Topol
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
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- Peter B. Berger
- From New York University School of Medicine (J.S.B.), New York, NY; University of Pennsylvania (J.S.B.), Philadelphia, Pa; VA Boston Healthcare System and Brigham and Women’s Hospital (D.L.B.), Boston, Mass; The Geisinger Clinic (S.R.S.), Danville, Pa; The Medicines Company (S.R.S.), Zurich Switzerland; Cleveland Clinic (M.S., A.M.L.), Cleveland, Ohio; INSERM U-698 (P.G.S.), Université Paris 7 and Assistance Publique–Hôpitaux de Paris, Paris, France; Institut de Cardiologie–Centre Hospitalier...
抄録
<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> Smoking increases platelet aggregability and the degree of platelet inhibition by clopidogrel on ex vivo platelet function tests. Whether smoking status affects the relationship between clopidogrel and clinical outcomes is unknown. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> We evaluated the relationship between smoking status (current smoker, former smoker, or never-smoker) and treatment with clopidogrel on the risk of all-cause, cardiovascular, and cancer mortality among the 12 152 participants from the CHARISMA (Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance) trial who had established cardiovascular disease. Current smoking was associated with an increase in all-cause (adjusted hazard ratio [HR] 2.58, 95% confidence interval [CI] 1.85 to 3.60), cardiovascular (HR 2.26, 95% CI 1.48 to 3.45), and cancer (HR 3.56, 95% CI 1.96 to 6.46) mortality compared with never smoking. The impact of clopidogrel on mortality differed by smoking status ( <jats:italic>P</jats:italic> for interaction=0.018 for current smokers). Among current smokers, clopidogrel was associated with a reduction in all-cause mortality (HR 0.68, 95% CI 0.49 to 0.94); clopidogrel did not reduce all-cause mortality among former smokers (HR 0.95, 95% CI 0.75 to 1.19) or never-smokers (HR 1.14, 95% CI 0.83 to 1.58). A similar pattern was noted for cardiovascular mortality. As expected, no relationship was observed between clopidogrel and cancer mortality by smoking status. The risk of bleeding appeared to differ according to smoking status; randomized clopidogrel was associated with a significantly increased risk of severe or moderate bleeding (HR 1.62, <jats:italic>P</jats:italic> =0.04) among current smokers but a smaller and nonsignificant increase among never-smokers (HR 1.31, <jats:italic>P</jats:italic> =0.15). </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> Clopidogrel therapy may be more effective in current smokers, but it may also confer a greater bleeding risk than in nonsmokers. Further studies are needed to investigate this possibility. </jats:p>
収録刊行物
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- Circulation
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Circulation 120 (23), 2337-2344, 2009-12-08
Ovid Technologies (Wolters Kluwer Health)