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

大麻是世界上最常见的非法物质，在美国的使用率越来越高 人口。虽然大麻除了对神经认知的影响外，对身体的危害还不够充分 经过研究，有一种看法认为它是安全的，对健康有好处。一个特别令人担忧的领域是其影响 大麻使用对心血管健康的影响。几个数据来源正在为一个新兴的假说做出贡献 单独使用大麻会增加心血管事件的风险。此外，大麻的使用 对记忆力、认知力和动力产生不利影响。因此，有可能大麻的使用与 服药依从性差，危险因素控制不佳，间接影响心血管健康。 为了解决关于大麻对心血管的潜在危害的文献中存在的巨大差距，我们 建议在退伍军人健康管理局(VA)建立65岁至67岁的患者队列， 使用合并的国家退伍军人管理局和医疗保险数据建立冠状动脉疾病(CAD)。具体来说，我们 建议使用文本处理方法来查看病历笔记并识别提到的大麻使用 初步将患者分为吸食大麻和不吸食大麻两类。然后我们将进行一场深入的 与每个患者进行电话健康访谈，以确定接触史(例如，大麻使用、烟草使用、 药物滥用、抑郁、自我报告的健康和体力活动)，并将比较心血管疾病 在860名当前吸食大麻的人和860名非吸食者中发生的事件。我们将利用海量数据 可在退伍军人管理局数据库中使用，以完善基线患者特征。对于这份修订后的申请，我们进行了 一项成功的试点研究，并证明了我们的患者识别和招募战略的可行性。 我们在这项提案中有三个目标：(1)检查大麻使用者和吸毒者之间的基线差异 非吸毒者，(2)检查大麻使用对服药依从性(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患上 即使在调整了药物依从性后，已确诊的冠心病患者的心血管事件， 风险因素控制和基线差异。我们将使用倾向评分方法来解决这些目标。 人们对大麻的身体危害知之甚少。大麻对心血管健康的任何影响 会对公众健康产生重大影响，因为心血管疾病是发病率的主要原因 以及美国的死亡率。这项提案将帮助公共卫生领导人准备好足够的公共卫生 应对合法化对健康的潜在不利影响。

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.