Impact of marijuana on adherence, risk factor control and cardiovascular events

大麻对依从性、危险因素控制和心血管事件的影响

• 批准号: 9404476
• 负责人: Salomeh Keyhani
• 金额: $ 72.99万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9404476
• 关键词: Acute myocardial infarction; Address; Adherence; Adolescent; Adrenergic beta-Antagonists; Adverse effects; Age-Years; Alcohol or Other Drugs use; Area; Benefits and Risks; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Case Study; Cerebrovascular Disorders; Cessation of life; Characteristics; Clinical Data; Cognition; Coronary Arteriosclerosis; Coronary heart disease; Data; Databases; District of Columbia; Drug abuse; Event; Goals; Grant; Health; Health Benefit; Health Professional; Health behavior; Heart; Incidence; Interview; Legal; Link; Literature; Low-Density Lipoproteins; Marijuana; Marijuana Smoking; Medical; Medical Records; Medicare; Memory; Mental Depression; Methods; Modeling; Morbidity - disease rate; Motivation; Myocardial; Myocardial Infarction; Neurocognitive; Orthostatic Hypotension; Oxygen; Particulate Matter; Patient Self-Report; Patients; Perception; Persons; Pharmaceutical Preparations; Physical activity; Physicians; Pilot Projects; Population; Postural syncope; Process; Prospective cohort study; Public Health; Published Comment; Rattus; Recording of previous events; Research; Rest; Risk; Risk Factors; Scoring Method; Smoking; Source; Stroke; Substance abuse problem; Supination; Tars; Telephone; Tetrahydrocannabinol; Text; Time; Tobacco; Tobacco smoke; Tobacco use; Toxin; Veterans; cardiovascular health; cardiovascular risk factor; cohort; endothelial dysfunction; health administration; insight; marijuana smoke; marijuana use; marijuana user; medication compliance; mortality; recruit; response; sedentary

Marijuana is the most common illegal substance used worldwide with increasing use among the US population. While the physical harms of marijuana outside of its neurocognitive effects have been inadequately studied, there is a perception that it is safe and has health benefits. One area of particular concern is the effect of marijuana use on cardiovascular health. Several sources of data are contributing to an emerging hypothesis that marijuana use independently increases the risk of cardiovascular events. In addition, marijuana use adversely impacts memory, cognition and motivation. Therefore it is plausible that marijuana use is associated with poor medication adherence and poor risk factor control and indirectly impacts cardiovascular health. To address the extensive gap in the literature on the potential cardiovascular harms of marijuana, we propose to construct a cohort of patients 65 to 67 years of age in the Veterans Health Administration (VA) with established coronary artery disease (CAD) using merged national VA and Medicare data. Specifically, we propose to use text processing methods to review medical record notes and identify mentions of marijuana use to preliminarily categorize patients into marijuana users and non-users. We will then perform an in-depth telephone health interview with each patient to ascertain exposure history (e.g., marijuana use, tobacco use, substance abuse, depression, self-reported health, and physical activity) and will compare the cardiovascular events among 860 current marijuana users and 860 non-users. We will leverage the vast amount of data available in VA databases to refine baseline patient characteristics. For this revised application, we conducted a successful pilot study and demonstrated the feasibility of our patient identification and recruitment strategy. We have three goals in this proposal: (1) to examine the baseline differences between marijuana users and non-users, (2) to examine the effect of marijuana use on medication adherence (e.g., beta blockers) and risk factor control (e.g., blood pressure) and 3) to examine if marijuana use independently increases the risk of cardiovascular events among patients with established CAD even after adjusting for medication adherence, risk factor control and baseline differences. We will use propensity score methods to address these aims. Very little is known about the physical harms of marijuana. Any effect of marijuana on cardiovascular health would have a substantial public health impact given that cardiovascular disease is the main cause of morbidity and mortality in the US. This proposal will help public health leaders prepare an adequate public health response to the potential adverse health effects of legalization.

大麻是全球最常见的非法物质，并且在美国的使用量不断增加 人口。尽管大麻对神经认知影响之外的身体危害尚未得到充分认识 经过研究，人们认为它是安全的并且对健康有益。特别值得关注的一个领域是效果 大麻使用对心血管健康的影响。多个数据来源正在促成一个新的假设 单独使用大麻会增加心血管事件的风险。此外，吸食大麻 对记忆、认知和动机产生不利影响。因此，大麻的使用可能与 用药依从性差，危险因素控制不佳，间接影响心血管健康。 为了解决有关大麻潜在心血管危害的文献中存在的巨大空白，我们 建议在退伍军人健康管理局 (VA) 构建一组 65 至 67 岁的患者队列 使用合并的国家 VA 和医疗保险数据确定了冠状动脉疾病 (CAD)。具体来说，我们 建议使用文本处理方法来审查病历记录并识别大麻使用的提及 初步将患者分为大麻使用者和非使用者。接下来我们将进行深入的 对每位患者进行电话健康访谈，以确定暴露史（例如吸食大麻、吸烟、 药物滥用、抑郁、自我报告的健康状况和体力活动），并将比较心血管疾病 860 名当前大麻使用者和 860 名非使用者之间的事件。我们将利用海量数据 可在 VA 数据库中使用，以完善基线患者特征。对于这个修改后的应用程序，我们进行了 一项成功的试点研究证明了我们的患者识别和招募策略的可行性。 我们在该提案中有三​​个目标：（1）检查大麻使用者和大麻使用者之间的基线差异 非使用者，(2) 检查大麻使用对药物依从性（例如β受体阻滞剂）和风险的影响 因素控制（例如血压）和 3）检查单独使用大麻是否会增加风险 即使在调整药物依从性后，已确诊 CAD 患者的心血管事件， 风险因素控制和基线差异。我们将使用倾向评分方法来实现这些目标。 人们对大麻对身体的危害知之甚少。大麻对心血管健康的任何影响 鉴于心血管疾病是发病的主要原因，将对公共卫生产生重大影响 和美国的死亡率。该提案将帮助公共卫生领导人为充分的公共卫生做好准备 应对合法化对健康的潜在不利影响。