ABSTRACT
Cannabis, or marijuana, has potential therapeutic and medicinal properties related to multiple compounds, particularly Δ-9-tetrahydrocannabinol and cannabidiol. Over the past 25 years, attitudes toward cannabis have evolved rapidly, with expanding legalization of medical and recreational use at the state level in the United States and recreational use nationally in Canada and Uruguay. As a result, the consumption of cannabis products is increasing considerably, particularly among youth. Our understanding of the safety and efficacy of cannabis has been limited by decades of worldwide illegality and continues to be limited in the United States by the ongoing classification of cannabis as a Schedule 1 controlled substance. These shifts in cannabis use require clinicians to understand conflicting laws, health implications, and therapeutic possibilities. Cannabis may have therapeutic benefits, but few are cardiovascular in nature. Conversely, many of the concerning health implications of cannabis include cardiovascular diseases, although they may be mediated by mechanisms of delivery. This statement critically reviews the use of medicinal and recreational cannabis from a clinical but also a policy and public health perspective by evaluating its safety and efficacy profile, particularly in relationship to cardiovascular health.
Subject(s)
American Heart Association , Cardiovascular System , Marijuana Smoking , Medical Marijuana/therapeutic use , Public Health , Canada , Humans , United StatesSubject(s)
Dyslipidemias/drug therapy , Hypolipidemic Agents/therapeutic use , Biological Transport , Cholesterol/blood , Cholesterol Ester Transfer Proteins/antagonists & inhibitors , Cholesterol, HDL/administration & dosage , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Dietary Supplements , Dyslipidemias/blood , Gain of Function Mutation , Humans , Hypolipidemic Agents/pharmacology , Liver X Receptors/agonists , Niacin/therapeutic use , Oligoribonucleotides, Antisense/therapeutic use , PCSK9 Inhibitors , Proprotein Convertase 9/blood , Proprotein Convertase 9/genetics , Recombinant Proteins/administration & dosageABSTRACT
BACKGROUND: The objective of the present study was to determine the effect of processing of pericardial blood with a cell-saving device (CS) and vacuum-assisted cardiopulmonary bypass (VACPB) on reduction of postoperative inflammation. METHODS: One hundred patients who underwent on-pump coronary artery bypass grafting surgery were included in a prospective randomized study. Patients were randomly assigned into four groups of 25 patients, each in a two-by-two factorial design: group A had no CS and no VACPB, group B had VACPB alone, group C had CS alone, and group D had CS and VACPB. The complement factors C4a, C3a, and C5a, and the terminal complex sC5b-9, MBL (mannose-binding lectin), and Bb were measured in plasma preoperatively and at 30 and 240 minutes after termination of CPB. RESULTS: Mean age, CPB, and aortic cross-clamping times were similar in all groups. At 30 and 240 minutes after CPB, C3a, sC5b-9, and Bb were increased and C5a and MBL levels were decreased compared with preoperative levels in all groups. At 240 minutes, Bb levels were lower in patients with CS (p = 0.0002). CONCLUSIONS: The present study shows that contemporary CPB remains associated with a striking activation of all complement pathways and its terminal component. The use of CS decreases the activation of the complement alternative pathway.
Subject(s)
Blood Transfusion, Autologous/instrumentation , Cardiopulmonary Bypass/methods , Complement Activation , Hypoxia-Ischemia, Brain/prevention & control , Inflammation/prevention & control , Aged , Analysis of Variance , Blood Flow Velocity , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/methods , Coronary Stenosis/mortality , Coronary Stenosis/surgery , Female , Humans , Male , Middle Aged , Pericardium , Postoperative Complications/prevention & control , Probability , Prospective Studies , Sensitivity and Specificity , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: An increase in the incidence of esophageal adenocarcinoma has coincided with a decrease in the prevalence of Helicobacter pylori infection. Whether these 2 phenomena are associated is unknown. METHODS: We conducted a nested case-control study of 128,992 members of an integrated health care system who had participated in a multiphasic health checkup (MHC) during 1964-1969. During follow-up, 52 patients developed esophageal adenocarcinoma. Three randomly chosen control subjects from the MHC cohort were matched to each case subject, on the basis of age at the MHC, sex, race, and the date and site of the MHC. Data on cigarette smoking, alcohol consumption, body mass index (BMI), and education level were obtained at the MHC. Serum samples collected at the MHC were tested for IgG antibodies to H. pylori and to the H. pylori CagA protein. RESULTS: Subjects with H. pylori infections were less likely than uninfected subjects to develop esophageal adenocarcinoma (odds ratio [OR], 0.37 [95% confidence interval (CI), 0.16-0.88]). This significant association was restricted to case subjects and control subjects <50 years old at the MHC (OR, 0.20 [95% CI, 0.06-0.68]). In patients with H. pylori infections, the OR for those who tested positive for IgG antibodies to the CagA protein was similar to that for those who tested negative for it. BMI >/=25 and cigarette smoking were strong independent risk factors for development of esophageal adenocarcinoma. CONCLUSION: The absence of H. pylori infection, independent of cigarette smoking and BMI, is associated with a markedly increased risk of development of esophageal adenocarcinoma.