Antiplatelet Drugs Prevent Adverse Cardiovascular Events More Effectively in Smokers

Randomized trials have shown that adenosine diphosphate receptor–blocker drugs such as clopidogrel, which inhibit platelets, prevent adverse cardiovascular (CV) events in patients with acute coronary syndromes. To determine whether smoking status is associated with the efficacy of antiplatelet drugs, researchers undertook a meta-analysis of six studies (74,000 patients with established CV disease, of whom 22,000 were smokers) in which clopidogrel was compared with a control intervention.

In four trials, clopidogrel plus aspirin was compared with aspirin alone; in one trial, clopidogrel alone was compared with aspirin alone; and, in one trial, single-dose clopidogrel was compared with double-dose clopidogrel. Follow-up ranged from 30 days to …