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

摘要 近年来，大麻及其成分（δ-9四氢大麻酚[THC]和大麻二酚[CBD]） 作为天然药物推广，并以慢性病患者为主要营销对象。 因此，与成年人相比，有潜在医疗条件的成年人更有可能使用大麻 没有医疗条件。这是令人震惊的，因为治疗益处或潜在风险的证据 大麻的使用普遍缺乏。此外，大麻使用对慢性前列腺炎临床病程的影响 疾病，这可能是重大的，是未知的。在这里，我们建议招募一个前瞻性的成年人队列， 早期高血压（BP）患者。这一相当大的人口（占美国成年人的30%）是 心血管疾病（CVD）的风险增加。我们将从初级保健诊所招募病人， 密歇根州，大麻是法律的成人消费，并使用数据从详细的问卷，物理 在30个月的研究中进行检查和收集生物标本，以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 和c）估计大麻使用轨迹与CVD的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 不断上升的高THC大麻吸烟轨迹将预测患者心血管风险状况恶化 与其他使用轨迹相比具有高BP（例如，高CBD，口服，停止）或不使用。 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， 他们缺乏这里提出的大麻和CVD测量。我们将研究的心血管健康的影响， 大麻使用，同时考虑到大麻的效力和给药途径。现有研究严重依赖 使用NIDA提供的大麻进行的受控实验室研究， 真实的世界。因此，对人类健康的普遍性和适用性仍然不确定。我们将采用一种移动的 药理学实验室的方法来评估大麻产品的效力提供给病人在密歇根州。 考虑到大麻政策最近的变化，这一建议是重要和及时的。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 密歇根州和该州的死亡原因与其他州相比排名很低。大麻使用的特点 轨迹及其与心血管健康的关系对大麻政策至关重要， 哪些轨迹与较少或较大的心血管风险相关，并传达这些风险， 减少对公众的伤害。我们的研究结果还将为医用大麻的建议提供信息，不仅 对于高血压患者，但对于需要大麻治疗厌食症的不同患者群体， 疼痛、焦虑或睡眠问题，并且CVD的风险增加（例如，艾滋病患者，抑郁症， 创伤应激障碍和神经病）。

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).