Heartfelt with Dr Melissa Walton-ShirleyView all posts »
Clopidogrel benefit greater in smokers --Rope benefit greater in those hanging on the side of a cliffApr 12, 2009 20:26 EDT
Well, Well, Well, what a headline. I'm suprised that RJ Reynolds or Phillip Morris hasn't already dressed a cowboy in a Tuxedo and placed the following caption in an ad in VOGUE stating: "smoking helps my blood thinner work better and it can work for you too".
Unfortunately, smoking still increases plaque rupture in the untreated portion of the blood vessel, and increases stroke, cancer and COPD rates, but those facts will not make headlines, at least not in VOGUE cigarette ads.
The ability to rev up Cyp1A2 by tobacco use is fascinating and a very helpful piece of information to spur other areas of research but I fear this fact will be mistranslated by the lay public. The fact that smoking can affect the metabolism of a compound is not new news. In 2003, published in the Journal of Psychopharmacology, there was a small study of 17 patients who demonstrated that the smoking group metabolized the antipsychotic zyprexa much more quickly........6x more quickly to be exact. That study also demonstrated that females and nonsmokers have a marked reduction in clearance of this medication . Smoking increases the metabolism of caffeine as well (thus the 2 pot per day habit that many smokers can tolerate whereas the rest of us would be begging adenosine in the ER for SVt after that much coffee). It also increases the metabolism of clozapine, flecanide, mexilitine, theophyllin, haldol and even inderal while it decreases the metabolism of xanax. (Hey, yet another advertising opportunity). Apparently, it's the polycyclic aromatic Hydrocarbons (PAH's) that induce the the CYP1A2 and it's these same PAH's that turn on certain genes that cause oxidation and increase cancer and inflammation.
So, it won't be long until this information will reach the general public. It's hard to translate it into a helpful way but I guarantee you that entities like the Blue Grass institute, pro tobacco lobbyists and "protectors" of the rights of smokers everywhere will be delighted to misinform and misinterpret it for our patients.
We can certainly explain this information in a true and helpful way to our patients, though it may be difficult for some to understand and for others, it will be just another excuse to keep smoking after an intervention.
All I can say is, If the rope and the Cliff illustration doesn't work, perhaps we can put on a Tuxedo and try again.