Fig. 4

Primary and secondary effects of aspirin, smoking, and ITGA2B gene expression on platelet function and MACE. Aspirin (1) and smoking (2) have primary, anti- and pro- thrombotic effects on platelet function, respectively. Secondary, compensatory effects of aspirin (3) and smoking (4) on ITGA2B expression are opposite their primary effects on platelet function and act to restore platelet function in a homeostatic manner (5, 6). ITGA2B expression represents a component of overall platelet function; higher levels (regardless of their cause) are associated with higher MACE risk. The overall effect of aspirin on MACE is the combination of its primary and compensatory effects (1, 3, and 5), and is protective. The effect of smoking on MACE is the combination of its primary and compensatory effects (2, 4, and 6), and overall increases risk