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

摘要 近年来，大麻及其成分(Delta-9四氢大麻酚[THC]和大麻二酚[CBD]) 作为天然药物进行推广，将慢性病患者作为突出的营销目标。 因此，与成年人相比，有潜在疾病的成年人更有可能使用大麻。 没有医疗条件。这是令人担忧的，因为与治疗益处或潜在风险相关的证据 普遍缺乏对大麻的使用。此外，大麻的使用对慢性阻塞性肺疾病临床病程的影响 疾病，可能是重大的，是未知的。在这里，我们建议招募一组预期的成年人 早期高血压(BP)患者。这个相当大的人口(占美国成年人总数的30%)是 心血管疾病(CVD)的高风险。我们将在#年从初级保健诊所招募病人。 密歇根州，在那里大麻成人消费是合法的，并使用来自详细问卷的数据，物理 在为期30个月的研究中进行检查和生物样品收集，以a)表征大麻的使用轨迹 在患者中，b)估计大麻使用轨迹和心血管风险状况之间的联系 和c)估计大麻使用轨迹与心血管疾病的基本机制之间的联系，包括 全身炎症、血小板聚集和动脉血管痉挛。我们假设坚持不懈或 高THC大麻吸食轨迹升级将预示患者心血管风险状况恶化 与其他使用轨迹(例如，高CBD、口服摄取、停止)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，结果喜忧参半。 他们缺乏这里提出的大麻和心血管疾病测量方法。我们将研究其对心血管健康的影响。 在考虑大麻效力和给药途径的同时使用大麻。现有的研究严重依赖于 关于使用NIDA供应的大麻进行的受控实验室研究，该大麻不同于 真实的世界。因此，对人类健康的概括性和适用性仍然不确定。我们将采用移动电话 评估密歇根州患者可获得的大麻产品效力的药理学实验室方法。 鉴于最近大麻政策的变化，这项建议是重要和及时的。2018年，密歇根州成为 中西部第一个将用于娱乐用途的大麻合法化的州。另一方面，CVD是领先的 密歇根州和该州的死因与其他州相比排名较低。大麻使用的特征 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 哪些轨迹与较少或更大的心血管风险相关，并传达这些风险 向公众提供减少危害的策略。我们的结果也将成为医用大麻建议的依据，不仅 对于高血压患者，但对于需要大麻治疗厌食症的不同群体的患者， 疼痛、焦虑或睡眠问题，并有更高的心血管疾病风险(例如，艾滋病毒携带者、抑郁症患者、 创伤性应激障碍和神经病)。

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).