title: Does "smoker's paradox" exist in clopidogrel-treated Turkish patients with acute coronary syndrome.
abstract: Previously conducted studies revealed that smoking enhanced the efficacy of clopidogrel by increasing formation of the active metabolite (AM) from the prodrug through induction of the cytochrome CYP1A2. The expression of cytochrome enzymes depends on genotype and no data exists in literature conducted in Turkish patients comparing the clopidogrel responsiveness between active smokers and non-active smokers treated with clopidogrel. In this study, our aim was to investigate the clopidogrel responsiveness in clopidogrel-treated Turkish acute coronary syndrome (ACS) patients according to their smoking status. We retrospectively enrolled 258 patients who were hospitalized due to ACS. Clinical variables of the patients, especially smoking status were recorded. Clopidogrel resistance was evaluated by using adenosine diphosphate (ADP) induced platelet aggregometry. Clopidogrel resistance was detected as a change in maximal aggregation ≤20% from baseline. A total of 139 patients were active smokers while 12 were former smokers. 107 patients did not have a history of smoking. Ten of the smokers were hyporesponsive to clopidogrel, whereas 36 of non-smokers were hyporesponsive to clopidogrel (p < 0.001). Receiver-operating characteristic curve analysis demonstrated that Au-min value >612.5 predicted the clopidogrel resistance with a sensitivity of 60% (OR: 100.65, %95 CI = 19.996-506.615 p < 0.001). Results of this study demonstrated that ADP responses were lower in smokers receiving clopidogrel and aspirin than in non-smokers receiving the same drug regimen. This finding indicates that smoking was related to an enhanced clopidogrel responsiveness in Turkish patients hospitalized due to ACS, suggesting that "smoker's paradox" probably exists in Turkish ACS patients.
authors.affiliation: a Department of Cardiology , Tınaztepe Hospital , Izmir , Turkey and.
authors.forename: Efe
authors.initials: E
authors.lastname: Edem
authors.affiliation: a Department of Cardiology , Tınaztepe Hospital , Izmir , Turkey and.
authors.forename: Ali Hikmet
authors.initials: AH
authors.lastname: Kirdök
authors.affiliation: a Department of Cardiology , Tınaztepe Hospital , Izmir , Turkey and.
authors.forename: Ahmet Ozan
authors.initials: AO
authors.lastname: Kınay
authors.affiliation: a Department of Cardiology , Tınaztepe Hospital , Izmir , Turkey and.
authors.forename: Ümit İlker
authors.initials: Üİ
authors.lastname: Tekin
authors.affiliation: b Department of Cardiology, Faculty of Medicine , Dokuz Eylül University , Izmir , Turkey.
authors.forename: Sedat
authors.initials: S
authors.lastname: Taş
authors.affiliation: b Department of Cardiology, Faculty of Medicine , Dokuz Eylül University , Izmir , Turkey.
authors.forename: Erkan
authors.initials: E
authors.lastname: Alpaslan
authors.affiliation: b Department of Cardiology, Faculty of Medicine , Dokuz Eylül University , Izmir , Turkey.
authors.forename: Mustafa Türker
authors.initials: MT
authors.lastname: Pabuccu
authors.affiliation: b Department of Cardiology, Faculty of Medicine , Dokuz Eylül University , Izmir , Turkey.
authors.forename: Bahri
authors.initials: B
authors.lastname: Akdeniz
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000188:drug therapy*; D000368:Aged; D000077144:Clopidogrel; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D012372:ROC Curve; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome; D014421:Turkey
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: 2-oxo-clopidogrel; Acute coronary syndrome; clopidogrel; drug resistance