Cannabis is used by over 200 million individuals worldwide; the adverse effects associated with cannabis have profound implications. CUD affects 27%-34% of cannabis users and has become a significant public health priority, given the absence of treatments and limited access to behavioral interventions.
Although research suggests adverse health outcomes due to cannabis usage, the relationship between cannabis and CVD is less explored. Current evidence suggests an increased rate of cardiovascular events among young cannabis users. Cannabis is also linked to severe events like stroke, myocardial infarction, arrhythmias, atherosclerosis, and cardiomyopathies.
In the present study, researchers assessed the associations between CUD and CVD outcomes using health administrative databases from Alberta, Canada. They used population-level data from the Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS), Alberta Practitioner Claims Database, Pharmaceutical Information Network, and Alberta Provincial Population Registry from 2012 to 2019.
The NACRS, Practitioner Claims Database, and DAD were used to identify individuals with CUD. Each subject with CUD was age- and gender-matched to an unexposed control individual with no documented CUD diagnosis code. The index date of cases when they were first diagnosed with CUD was also assigned to the matched control.
The study’s primary outcome was incident CVD events (myocardial infarction, ischemic heart disease, unstable angina, peripheral vascular disease, cardiac dysrhythmias, ischemic stroke, or heart failure). Individuals with a prior history of CVD events were excluded. Each individual was followed up until an incident CVD event, death, or December 31, 2019.
The study covariates were the Charlson comorbidity index (CCI)), material (MDI) and social (SDI) deprivation indices, anatomical therapeutic chemical (ATC) subgroup count, mental health comorbidities, and healthcare utilization. The 2012 mid-year population of Alberta was used to estimate the point prevalence of CUD. Survival analysis was performed using the Kaplan-Meier method.
The log-rank test computed the associations between CUD and CVD, accounting for censoring by mortality. In stratified analyses, crude rate ratios (RRs) and 95% confidence intervals were estimated. The Mantel-Haenszel technique was used to pool estimates when stratum-specific estimates were similar, yielding adjusted RRs. Dose-response relationships were also evaluated.
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