Association Between Marijuana Use and Cardiovascular Disease in US Adults.

Introduction The prevalence of marijuana use has increased by about 16% since 2006, translating to approximately 200 million people worldwide. Being so widely used, long-term effects of marijuana use on cardiovascular health are largely unknown. Previous studies have had conflicting results, either showing marijuana use having a negative impact or no significant impact on cardiovascular health. This study aims to add evidence regarding the impact marijuana use has on the prevalence of cardiovascular disease. Methods This retrospective study was conducted using the Behavioral Risk Factor Surveillance System (BRFSS) database. Patients who completed the questionnaire and answered all questions in relation to marijuana use and the diagnosis of cardiovascular disease in 2017 were a part of this study. Subjects were excluded if they were children (<18 years old) or had missing data for marijuana use or cardiovascular disease. Age, gender, race/ethnicity, body mass index (BMI), income, exercise, tobacco use, alcohol use, and depression were all considered as potential confounders. Bivariate analysis was conducted to find an initial association between marijuana use and cardiovascular disease, which was followed by a multivariate regression analysis to adjust for confounders. Odds ratios and 95% confidence intervals were calculated.  Results A total of 56,742 subjects were included in the analysis. The unadjusted bivariate analysis showed a reduced prevalence of cardiovascular disease in individuals using marijuana (OR 0.65, 95%CI [0.50-0.84]). After adjustment with all additional variables, an adjusted model showed a similar odds ratio, but statistical significance of the association was lost (OR 0.74, 95%CI [0.54-1.01]). Discussion A systematic review by Ravi et al in 2018, which looked at marijuana use, cardiovascular risk factors, and clinical outcomes concluded that there was insufficient data to make conclusions regarding the effect of marijuana use and negative long-term cardiovascular effects. Our study lends support to the notion that marijuana use does not have an association with cardiovascular disease. A limitation in our study was that there was missing data from the BRFSS questionnaire due to participants not fully answering all questions concerning cardiovascular disease and marijuana use. This decreased our sample size from 67,974 to 56,742 subjects. The missing participants led to a decrease in the power of our odds ratio, which may have impacted statistical significance of our results.  Conclusion Although previous literature has shown that marijuana use has a negative impact on cardiovascular health, our study suggests that users and non-users of marijuana did not have an association with the prevalence of cardiovascular disease. Varying levels of support within the literature highlights the need for further research of this association.

Emergency Department Visit Within One Year Prior to Elective Total Joint Arthroplasty Is Predictive of Postoperative Return to Emergency Department Within 90 Days.

BACKGROUND: The Comprehensive Care for Joint Replacement Model, developed by Centers for Medicare and Medicaid Services, aims to improve the quality of joint replacement. Metrics including emergency room visit rates after primary total knee and total hip arthroplasty (TKA and THA) are of particular interest. The purpose of this study is to determine if preoperative emergency department (ED) visits are predictive of postoperative ED visits among patients undergoing elective THA or TKA. METHODS: In a retrospective analysis of 6996 patients who underwent elective primary arthroplasty (2453 hips, 4543 knees), we identified all patients who had an ED visit from up to 1 year prior to their surgical date to 90 days after. We assessed if preoperative visit frequency or temporality is predictive of a return to the ED visit within 90 days. RESULTS: TKA and THA patients with a single preoperative ED visit had an odds ratio of 1.9 and 2.0, respectively, of returning to the emergency room postoperatively (P < .001). Increasing preoperative visit frequency correlated with increasing odds ratios (1.9-16.7, P < .001). The proximity of the most recent preoperative visit prior to surgery had a positive trend toward a larger effect, but did not clearly demonstrate a dose-dependent effect. CONCLUSION: Presentation to the ED is common prior to total joint arthroplasty and is predictive of a postoperative visit within 90 days. Increasing preoperative visit frequency further increases a patient's risk of a postoperative visit within 90 days.