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2 Minute Medicine Rewind Mar 21, 2022
1. Immediate acquisition of medical marijuana cards was associated with increased prevalence and severity of cannabis use disorder symptoms, with improvements in self-rated insomnia symptoms.
Evidence Rating Level: 1 (Excellent)
Cannabis use has increased in prevalence in recent years with claims of benefits for pain, sleep, anxiety and mood symptoms and legitimization of its use for these health concerns with medical marijuana cards. Despite its accessibility, there is a paucity of evidence surrounding the efficacy and risk profile of medical marijuana. In addition, rates of addiction in adults with medical marijuana cards in comparison to those who use it for recreational purposes have not been well-established. This single-blind randomized controlled trial recruited 186 participants in the Greater Boston area aged 18 to 65 with medical marijuana cards for the above concerns. Patients with substance use disorders, daily cannabis use and psychosis were excluded. Participants were randomized to either the immediate card acquisition group (n=105) and delayed card acquisition group (n=81, with a delay of 12 weeks to receive the card), while cannabis product dosage and frequency were selected by participants themselves using the card in lieu of physician recommendations. Primary outcomes were cannabis use symptoms, anxiety, depressive and insomnia symptoms and pain severity, while secondary outcomes were physical, cognitive and mental health scores. The immediate card acquisition group had significantly more cannabis use disorder symptoms (MD, 0.28; 95% CI, 0.15-0.40; P < .001) and improved self-rating of insomnia symptoms (MD, –2.90; 95% CI, –4.31 to –1.51; P < .001). Overall, immediate acquisition of medical marijuana cards may be associated with increased risk of cannabis use disorder, while benefits for anxiety, pain and mood symptoms require further study.
1. Black patients living with others with intensive blood pressure control had significantly lower risk of adverse cardiovascular events secondary to hypertension than Black patients living alone.
Evidence Rating Level: 1 (Excellent)
Hypertension, a driver of cardiovascular disease and death, has been associated with racial disparities in prevalence and control. Complex mechanisms including biological, environmental, and social factors are believed to affect hypertension and cardiovascular health, but are not well understood. This secondary post hoc analysis utilized data from 9342 patients enrolled in SPRINT, a multicenter randomized controlled trial to identify any potential association of cardiovascular outcomes with different living arrangements in Black and non-Black patients. Participants were randomized to an intensive treatment group (systolic blood pressure target of < 120 mmHg) or standard treatment group (target blood pressure < 140 mmHg). The main outcome was an incident composite cardiovascular endpoint comprised of myocardial infarction, acute coronary syndrome, stroke, acute decompensated heart failure or CVD death. Secondary outcomes included all-cause mortality. There was a significantly lower rate of composite cardiovascular outcome within the intensive treatment group, compared to Black patients in the standard treatment group living with others (HR 0.53, 95% CI 0.33-0.85) but not among those living alone (HR, 1.07, 95% CI 0.66-1.73), p = .04). This association was present in non-Black patients regardless of living arrangement status. These findings raise implications for future research on cardiovascular risk reduction in socially isolated Black individuals.
1. Left atrial reservoir strain predicted hospitalization and all-cause mortality in heart failure patients with a specificity of 84% and sensitivity of 83%.
2. Left atrial reservoir strain was significantly inversely associated with NT-proBNP.
Evidence Rating Level: 2 (Good)
Left atrial reservoir strain (LASr) approximates 40% in healthy individuals. Increasing evidence suggests that LASr may also be valuable in prognosticating and diagnosing heart failure (HF), similar to NT-proBNP and left ventricular ejection fraction, respectively. This prospective, observational study investigated the correlation between LASr and NT-proBNP in an outpatient cohort of 174 patients. The outcome was a composite of HF hospitalization and all-cause mortality within 1 year. All patients underwent a transthoracic echocardiogram with speckle tracking echocardiography of the left atrium. At baseline, patients were predominantly male (69%), median age was 69 years, and a majority of patients (43%) had heart failure with reduced ejection fraction. There was an inverse correlation between LASr and log-transformed NT-proBNP (r=-0.75, p < 0.01). The primary outcome was predicted with similar specificity across LASr and NT-proBNP (84% and 83%), while sensitivity of LASr was lower (61% and 70%). These findings lend credence to potential usage of LASr as a predictor of heart failure outcomes, but future studies with larger study populations are required.
1. Higher protein intake from animal, red meat and processed sources were associated with deteriorations in health-related quality of life scores over 12 years.
Evidence Rating Level: 2 (Good)
Muscle mass and physical performance are positively associated with higher health-related quality of life (HRQoL), but the relationship between dietary protein intake and HRQoL has not been well established. This 12-year population-based prospective cohort study followed a subset of 752 patients from the AusDiab study who were aged 60 years and older. Habitual dietary intake was assessed via self-administration of a food frequency questionnaire, while HRQoL information was collected via a self-administered short-form 36-item questionnaire that provided physical component summary (PCS) and mental component summary (MCS) scores. The results indicated deteriorations in PCS scores following higher animal, red meat and processed animal protein intake (β = − 0.04; 95% CI: − 0.07, −0.01 ; p = 0.009; β = − 0.05; 95% CI: − 0.08, − 0.01; p = 0.018; β = − 0.17; 95% CI: − 0.31, − 0.02; p = 0.027). Lower MCS scores were also associated with higher red meat consumption (β = -0.04; 95% CI -0.08, -0.01; p=0.011). 12-year PCS and MCS was not significantly different between participants consuming different quantities of total protein. However, given high amounts of attrition of older patients with more comorbidities, these findings should be corroborated by future studies.
1. Rates of new neurological events including Guillain-Barré syndrome following COVID-19 vaccination were consistent with background rates in the general population.
Evidence Rating Level: 3 (Average)
Following introduction of anti-SARS-CoV-2 vaccines, reports have emerged about novel neurological events, including Guillain-Barré syndrome, transverse myelitis, Bell’s palsy and encephalomyelitis, post-COVID-19 vaccination. However, few large scale epidemiological studies have investigated the presence of a temporal association between vaccination and neurological events. This population based historical rate comparison study with self-controlled case series analysis, recruited 8,330,497 patients who received at least one dose of a COVID-19 vaccine. Participants were followed from the index date until the end of follow-up, first occurrence of adverse events and end of data availability. In this group, there were 144 Bell’s Palsy events, 16 encephalomyelitis events, 11 Guillain-Barré events, and fewer than 5 transverse myelitis events. Rates of neurological events following COVID-19 vaccination were consistent with background rates, but did increase following SARS-CoV-2 infection: standardised incidence ratios were 1.33 for Bell’s Palsy (1.02 to 1.74), 6.89 for encephalitis (3.82 to 12.44), and 3.53 for Guillain-Barré syndrome (1.83 to 6.77).
Image: PD
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