Smoker's Paradox

Q; What is "smoker’s paradox"?

Answer: Smoker's paradox is a troubling phenomenon in cardiovascular patients. A population of patients who are nonsmokers may tend to have decrease response to clopidogrel, an essential treatment in most "stented patients". Smoking stimulates CYP1A2 and so enhances platelet inhibition by clopidogrel. Interestingly, once smoking is stopped, which is an universal recommendation, this benefit is lost.


References:

1. Desai NR, Mega JL, Jiang S, et al. Interaction between cigarette smoking and clinical benefit of clopidogrel. J Am Coll Cardiol 2009; 53:1273. 

2. Gurbel PA, Nolin TD, Tantry US. Clopidogrel efficacy and cigarette smoking status. JAMA 2012; 307:2495. 

3. The association of cigarette smoking with enhanced platelet inhibition by clopidogrel. J Am Coll Cardiol 2008; 52:531. 

4. Park KW, Kang SH, Kang J, et al. Enhanced clopidogrel response in smokers is reversed after discontinuation as assessed by VerifyNow assay: additional evidence for the concept of 'smokers' paradox'. Heart 2012; 98:1000.