Desai Rupak, Brereton Brian, Patta Harika Varma Chintapalli, Bansal Prerna, Jain Akhil, Vyas Ankit
Division of Cardiology, Atlanta VA Medical Center, Decatur, GA, USA.
Department of Medicine, Jersey General Hospital, St. Helier, Jersey.
Curr Probl Cardiol. 2024 Jan;49(1 Pt C):102162. doi: 10.1016/j.cpcardiol.2023.102162. Epub 2023 Oct 21.
Given current evidence linking peripheral atherosclerotic disease, also known as cannabis arteritis, and acute ischemic stroke (AIS) in individuals with cannabis use disorder (CUD), we investigated the frequency and implications of CUD in relation to AIS risk and outcomes among elderly patients with peripheral vascular disease (PVD).
The National Inpatient Sample (2016-2019) was used to compare geriatric patients with PVD and cannabis use disorder CUD. CUD was correlated with AIS admissions. Adjusted multivariable regression models assessed in-hospital mortality rates.
Of 5,115,824 geriatric admissions with PVD, 50.6 % were male and 77.5 % were white. 21,405 admissions had cardiovascular and CUD co-occurrence. 19.7 % of CUD patients had diabetes mellitus (DM), compared to 33.7 % of non-CUD patients. Smoking and HTN rates were comparable between groups. Patients with CUD used more recreational drugs concurrently than those without CUD. AIS prevalence was 5.2 % in CUD patients and 4.0 % in controls (p < 0.001). In the geriatric population with PVD, the presence of CUD was found to be associated with increased odds of hospitalizations due to AIS, with an adjusted odds ratio (aOR) of 1.34 (95 % confidence interval [CI] 1.18-1.52, p < 0.001). All-cause in-hospital mortality was not statistically significant, with an aOR of 0.71 (95 %CI 0.36-1.37, p = 0.302). In our study, older patients with PVD and hypertension (aOR 1.73) had a greater risk of AIS. Intriguingly, when we analyzed AIS predictors in elderly PVD patients with concurrent tobacco use disorder, we identified a counterintuitive protective effect (aOR 0.58, 95 % CI 0.42-0.79, p < 0.001).
Our findings indicate that among geriatric patients with PVD and concurrent CUD, there is a notable 34 % risk of AIS. Importantly, this risk persists despite controlling for other CVD risk factors and substance use. Further investigations are warranted to elucidate and validate the intriguing phenomenon known as the smoker's paradox.
鉴于目前有证据表明，在患有大麻使用障碍（CUD）的个体中，外周动脉粥样硬化疾病（也称为大麻动脉炎）与急性缺血性卒中（AIS）有关，我们调查了老年外周血管疾病（PVD）患者中CUD的发生率及其与AIS风险和预后的关系。
使用国家住院患者样本（2016 - 2019年）比较患有PVD和大麻使用障碍（CUD）的老年患者。CUD与AIS入院情况相关。调整后的多变量回归模型评估住院死亡率。
在5115824例患有PVD的老年住院患者中，50.6%为男性，77.5%为白人。21405例患者同时患有心血管疾病和CUD。19.7%的CUD患者患有糖尿病（DM），而非CUD患者的这一比例为33.7%。两组的吸烟率和高血压发生率相当。患有CUD的患者同时使用更多娱乐性药物。CUD患者中AIS患病率为5.2%，对照组为4.0%（p < 0.001）。在患有PVD的老年人群中，发现CUD的存在与因AIS住院的几率增加相关，调整后的优势比（aOR）为1.34（95%置信区间[CI] 1.18 - 1.52，p < 0.001）。全因住院死亡率无统计学意义，aOR为0.71（95%CI 0.36 - 1.37，p = 0.302）。在我们的研究中，患有PVD和高血压的老年患者（aOR 1.73）发生AIS的风险更高。有趣的是，当我们分析同时患有烟草使用障碍的老年PVD患者的AIS预测因素时，我们发现了一种与直觉相反的保护作用（aOR 0.58，95%CI 0.42 - 0.79，p < 0.001）。
我们的研究结果表明，在患有PVD且同时患有CUD的老年患者中，发生AIS的风险显著为34%。重要的是，尽管控制了其他心血管疾病风险因素和物质使用情况，这种风险仍然存在。有必要进行进一步调查，以阐明和验证被称为吸烟者悖论的有趣现象。
