Cumulative Marijuana Use and Carotid Intima-Media Thickness at Middle Age: The CARDIA Study

Julian Jakob,Roman Von Wyl,Odile Stalder,Mark J Pletcher,Eric Vittinghoff,Kali Tal,Jamal S Rana,Stephen Sidney,Jared P Reis,Reto Auer

doi:10.1016/j.amjmed.2020.11.026

Abstract

BackgroundLong-term cardiovascular health effects of marijuana are understudied. Future cardiovascular disease is often indicated by subclinical atherosclerosis for which carotid intima-media thickness is an established parameter. MethodsUsing the data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of 5115 Black and white women and men at Year 20 visit, we studied the association between carotid intima-media thickness in midlife and lifetime exposure to marijuana (1 marijuana year = 365 days of use) and tobacco smoking (1 pack-year = 20 cigarettes/day for 365 days). We measured carotid intima-media thickness by ultrasound and defined high carotid intima-media thickness at the threshold of the 75th percentile of all examined participants. We fit logistic regression models stratified by tobacco smoking exposure, adjusting for demographics, cardiovascular risk factors, and other drug exposures. ResultsData was complete for 3257 participants; 2722 (84%) reported ever marijuana use; 374 (11%) were current users; 1539 (47%) reported ever tobacco smoking; 610 (19%) were current smokers. Multivariable adjusted models showed no association between cumulative marijuana exposure and high carotid intima-media thickness in never or ever tobacco smokers, odds ratio (OR) 0.87 (95% confidence interval [CI]: 0.63-1.21) at 1 marijuana-year among never smokers and OR 1.11 (95% CI: 0.85-1.45) among ever tobacco smokers. Cumulative exposure to tobacco was strongly associated with high carotid intima-media thickness, OR 1.88 (95%CI: 1.20-2.94) for 20 pack-years of exposure. ConclusionsThis study adds to the growing body of evidence that there might be no association between the average population level of marijuana use and subclinical atherosclerosis.

Highlights

Background/rationale Objectives Methods Study design Setting ParticipantsVariables Data sources/ measurement Bias Study size Quantitative variables Statistical methods
The distribution of high normalized composite carotid intima-media thickness, composite carotid intima-media thickness, and common carotid, carotid bulb, and internal carotid intima-media thickness varied between never and ever tobacco smokers (Table 2). Among those who never smoked tobacco, cumulative marijuana-years were not associated with any carotid intima-media thickness measure in unadjusted or multivariable adjusted models (Table 3, Figure 1 A)
Cumulative marijuana-years was associated with high common carotid intima-media thickness measures in unadjusted models but not after multivariable adjustment (Table 3 Figure 1B)

Summary

Introduction

Background/rationale Objectives Methods Study design Setting ParticipantsVariables Data sources/ measurement Bias Study size Quantitative variables Statistical methods. METHODS: Using the data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of 5115 Black and white women and men at Year 20 visit, we studied the association between carotid intima-media thickness in midlife and lifetime exposure to marijuana (1 marijuana year = 365 days of use) and tobacco smoking (1 pack-year = 20 cigarettes/day for 365 days). Multivariable adjusted models showed no association between cumulative marijuana exposure and high carotid intima-media thickness in never or ever tobacco smokers, odds ratio (OR) 0.87 (95% confidence interval [CI]: 0.63-1.21) at 1 marijuana-year among never smokers and OR 1.11 (95% CI: 0.85-1.45) among ever tobacco smokers. Cumulative exposure to tobacco was strongly associated with high carotid intima-media thickness, OR 1.88 (95%CI: 1.20-2.94) for 20 pack-years of exposure.

Results

Discussion

Conclusion