Cannabis use and cardiovascular health outcomes among patients with high blood pressure

高血压患者的大麻使用和心血管健康结果

• 批准号: 10736413
• 负责人: Omayma O Alshaarawy
• 金额: $ 54.23万
• 依托单位: HENRY FORD HEALTH + MICHIGAN STATE UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736413
• 关键词: Acute; Adult; Affect; Anorexia; Anxiety; Area; Atherosclerosis; Blood; Blood Pressure; Blood Vessels; Blood specimen; Cannabidiol; Cannabinoids; Cannabis; Cannabis policy; Cannabis retail; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Chest Pain; Chronic; Chronic Disease; Clinical; Collection; Communication; Consumption; Data; Diagnosis; Diastolic blood pressure; Early Diagnosis; Enrollment; Epilepsy; Event; Feasibility Studies; Fibrinogen; Free Radicals; Goals; Growth; HIV; Harm Reduction; Health; Health Status; Home; Homeostasis; Human; Hypertension; Immune; Immune response; Individual; Inflammation; Inflammatory; Ingestion; Inhalation; Knowledge; Laboratories; Laboratory Study; Legal; Malignant Neoplasms; Marijuana Smoking; Marketing; Measurement; Measures; Medical; Medical Marijuana; Mental Depression; Michigan; Midwestern United States; Modeling; National Institute of Drug Abuse; Natural Remedy; Neuropathy; Oral Ingestion; Organ; Outcome; Pain; Patient Recruitments; Patients; Pattern; Pharmacology; Physiological; Platelet aggregation; Population; Post-Traumatic Stress Disorders; Prevalence; Production; Prospective Studies; Prospective cohort; Questionnaires; Recommendation; Recreation; Reporting; Research; Risk; Route; Sleep Disorders; Smoking; Stress; Tetrahydrocannabinol; Therapeutic; Time; United States; Urinalysis; Vasospasm; Work; Youth; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; childhood epilepsy; cohort; cytokine; epidemiology study; health warning; innovation; interest; marijuana legalization; marijuana use; marijuana user; non-drug; normotensive; physical conditioning; poor sleep; primary care clinic; recruit; research study; sleep quality; sound; systemic inflammatory response

ABSTRACT In recent years, cannabis, and its constituents (delta-9 tetrahydrocannabinol [THC] and cannabidiol [CBD]) have been promoted as natural remedies, with chronic disease patients as prominent marketing targets. Consequently, adults with underlying medical conditions are more likely to use cannabis compared to adults without medical conditions. This is alarming given that evidence for therapeutic benefits or potential risks related to cannabis use is generally lacking. Additionally, the impact of cannabis use on the clinical course of chronic diseases, which could be significant, is unknown. Here, we propose to recruit a prospective cohort of adult patients with early-stage high blood pressure (BP). This sizable population (30% of all United States adults) are at a heightened risk for cardiovascular disease (CVD). We will recruit patients from primary care clinics in Michigan, where cannabis is legal for adult consumption, and use data from detailed questionnaires, physical exams and biospecimen collections across the 30-month study to a) characterize cannabis use trajectories among patients, b) estimate the association between cannabis use trajectories and cardiovascular risk status and c) estimate the association between cannabis use trajectories and underlying mechanisms of CVD including systemic inflammation, platelet aggregation and arterial vasospasm. We hypothesize that persistent or escalating high THC cannabis smoking trajectories will predict worsened cardiovascular risk status in patients with high BP compared to other use trajectories (e.g., high CBD, oral ingestion, cessation) or non-use. Epidemiological studies on the cardiovascular health effects of cannabis are scarce, their results are mixed, and they lack cannabis and CVD measurements proposed here. We will study the cardiovascular health effects of cannabis use while accounting for cannabis potency and route of administration. Existing research relied heavily on controlled laboratory studies, conducted using NIDA-supplied cannabis that differs from cannabis used in the real world. Hence, generalizability and applicability to human health remain uncertain. We will adapt a mobile pharmacology laboratory approach to assess the potency of cannabis products available to patients in Michigan. This proposal is important and timely given the recent changes in cannabis policies. In 2018, Michigan became the first state in the Midwest to legalize cannabis for recreational use. On the other hand, CVD is the leading cause of death in Michigan and the state rank poorly relative to other states. Characterizing cannabis use trajectories and how they relate to cardiovascular health over time is essential for cannabis policies, to identify which trajectories are associated with fewer or greater cardiovascular risks and communicate these risks and harm reduction strategies to the public. Our results will also inform medical cannabis recommendations, not only for patients with high BP, but for a diverse group of patients who need cannabis for the management of anorexia, pain, anxiety, or sleep problems, and are at increased risk of CVD (e.g., patients with HIV, depression, post- traumatic stress disorder and neuropathies).

抽象的 近年来，大麻及其成分（delta-9 四氢大麻酚 [THC] 和大麻二酚 [CBD]） 被作为自然疗法进行推广，慢性病患者成为突出的营销目标。 因此，与成年人相比，患有基础疾病的成年人更有可能使用大麻 没有医疗条件。鉴于治疗益处或潜在风险的证据表明，这一点令人震惊 大麻的使用普遍缺乏。此外，使用大麻对慢性病临床病程的影响 可能严重的疾病尚不清楚。在这里，我们建议招募一群前瞻性的成年人 早期高血压（BP）患者。这个相当大的人口（占所有美国成年人的 30%） 患心血管疾病（CVD）的风险较高。我们将从初级保健诊所招募患者 密歇根州，成人消费大麻是合法的，并使用来自详细调查问卷、身体检查和身体检查的数据。 为期 30 个月的研究中的检查和生物样本收集 a) 描述大麻使用轨迹 在患者中，b）估计大麻使用轨迹与心血管风险状态之间的关联 c) 估计大麻使用轨迹与 CVD 潜在机制之间的关联，包括 全身炎症、血小板聚集和动脉血管痉挛。我们假设持续或 高 THC 大麻吸烟轨迹的升级将预测患者心血管风险状况恶化 与其他使用轨迹（例如高 CBD、口服摄入、戒烟）或不使用相比，血压较高。 关于大麻对心血管健康影响的流行病学研究很少，其结果好坏参半，并且 他们缺乏此处提出的大麻和 CVD 测量。我们将研究对心血管健康的影响 大麻的使用，同时考虑大麻的效力和给药途径。现有研究严重依赖 受控实验室研究，使用 NIDA 提供的大麻进行，该大麻不同于 现实世界。因此，其对人类健康的普遍性和适用性仍然不确定。我们将适配手机 药理学实验室方法评估密歇根州患者可获得的大麻产品的效力。 鉴于最近大麻政策的变化，该提案非常重要且及时。 2018 年，密歇根州成为 中西部第一个将娱乐用大麻合法化的州。另一方面，CVD 是领先的。 与其他州相比，密歇根州和该州的死亡原因排名较差。大麻使用特征 随着时间的推移，轨迹及其与心血管健康的关系对于大麻政策至关重要，以确定 哪些轨迹与较少或较高的心血管风险相关，并传达这些风险和 对公众的减少伤害战略。我们的结果还将为医用大麻建议提供信息，不仅 对于高血压患者，但对于需要大麻来治疗厌食症的不同患者群体， 疼痛、焦虑或睡眠问题，并且患 CVD 的风险增加（例如，艾滋病毒患者、抑郁症患者、术后 创伤性应激障碍和神经病）。