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，在美国的使用越来越多。 人口虽然大麻在其神经认知效应之外的身体伤害还不充分， 研究表明，人们认为它是安全的，对健康有益。一个特别令人关注的领域是 对心血管健康的影响几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，使用大麻 对记忆力、认知力和动力都有负面影响。因此，大麻的使用与 药物依从性差和风险因素控制差，间接影响心血管健康。 为了解决文献中关于大麻潜在心血管危害的广泛空白，我们 建议在退伍军人健康管理局（VA）建立一个年龄在65至67岁之间的患者队列， 使用合并的国家VA和Medicare数据确定冠状动脉疾病（CAD）。我们特别 我建议使用文本处理方法来审查医疗记录笔记，并识别大麻使用的提及 初步将患者分为吸食大麻者和不吸食大麻者。然后我们将进行深入的 与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，抑郁症，自我报告的健康状况和身体活动），并将比较心血管 860名大麻使用者和860名非使用者之间的事件。我们将利用大量的数据 可在VA数据库中获得，以细化基线患者特征。对于此修订后的应用程序，我们进行了 这是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。 我们在这个提案中有三个目标：（1）检查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的影响（例如，β受体阻滞剂）和风险 因子控制（例如，血压）和3）检查大麻的使用是否会独立增加 即使在调整药物依从性后， 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 鉴于心血管疾病是发病的主要原因， 死亡率在美国。这项建议将有助于公共卫生领导人准备一个充分的公共卫生 对合法化的潜在不利健康影响的反应。

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.