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Canadian Journal of Cardiology

Prevalence and Effects of Cigarette Smoking, Cannabis Consumption, and Co-use in Adults From 15 Countries With Congenital Heart Disease

Published:August 14, 2019DOI:https://doi.org/10.1016/j.cjca.2019.07.635

      Abstract

      Background

      The prevalence and effects of cigarette smoking and cannabis use in persons with congenital heart disease (CHD) are poorly understood. We (1) described the prevalence of cigarette smoking, cannabis consumption, and co-use in adults with CHD; (2) investigated intercountry differences; (3) tested the relative effects on physical functioning, mental health, and quality of life (QOL); and (4) quantified the differential effect of cigarette smoking, cannabis use, or co-use on those outcomes.

      Methods

      APPROACH-IS was a cross-sectional study, including 4028 adults with CHD from 15 countries. Patients completed questionnaires to measure physical functioning, mental health, and QOL. Smoking status and cannabis use were assessed by means of the Health Behaviour Scale—Congenital Heart Disease. Linear models with doubly robust estimations were computed after groups were balanced with the use of propensity weighting.

      Results

      Overall, 14% of men and 11% of women smoked cigarettes only; 8% of men and 4% of women consumed cannabis only; and 4% of men and 1% of women used both substances. Large intercountry variations were observed, with Switzerland having the highest prevalence for smoking cigarettes (24% of men, 19% of women) and Canada the highest for cannabis use (19% of men, 4% of women). Cigarette smoking had a small negative effect on patient-reported outcomes, and the effect of cannabis was negligible. The effect of co-use was more prominent, with a moderate negative effect on mental health.

      Conclusions

      We found significant intercountry variability in cigarette and cannabis use in adults with CHD. Co-use has the most detrimental effects on patient-reported outcomes.

      Résumé

      Contexte

      La prévalence et les effets de la consommation de tabac et de cannabis chez les personnes présentant une cardiopathie congénitale sont mal compris. Nous avons : 1) décrit la prévalence du tabagisme, de la consommation de cannabis et de l’utilisation concomitante de tabac et de cannabis chez des adultes présentant une cardiopathie congénitale; 2) étudié les différences entre pays; 3) examiné les effets relatifs sur le fonctionnement physique, la santé mentale et la qualité de vie (QdV); et 4) quantifié l’effet différentiel du tabagisme, de la consommation de cannabis et de l’emploi concomitant de tabac et de cannabis sur ces paramètres.

      Méthodologie

      APPROACH-IS est une étude transversale menée auprès de 4 028 adultes présentant une cardiopathie congénitale dans 15 pays. Les patients ont répondu à des questionnaires visant à évaluer leur fonctionnement physique, leur santé mentale et leur QdV. Le tabagisme et la consommation de cannabis ont été évalués au moyen de l’échelle HBS-CHD (Health Behaviour Scale – Congenital Heart Disease, pour l’évaluation des comportements liés à la santé chez les personnes atteintes d’une cardiopathie congénitale). Des modèles linéaires et des estimations doublement robustes ont été appliqués après équilibrage des groupes au moyen de scores de propension.

      Résultats

      Dans l’ensemble, 14 % des hommes et 11 % des femmes fumaient la cigarette seulement; 8 % des hommes et 4 % des femmes consommaient du cannabis seulement; et 4 % des hommes et 1 % des femmes fumaient la cigarette et consommaient du cannabis. De grandes variations entre pays ont été observées; le tabagisme était plus prévalent en Suisse (24 % des hommes et 19 % des femmes), tandis que la consommation de cannabis était plus élevée au Canada (19 % des hommes et 4 % des femmes). Le tabagisme avait un léger effet négatif sur les résultats rapportés par les patients, tandis que l’effet du cannabis était négligeable. L’utilisation concomitante du tabac et du cannabis avait un effet plus marqué, et influait de façon modérément négative sur la santé mentale.

      Conclusions

      Nous avons observé une grande variabilité entre les pays à l’égard de la consommation de tabac et de cannabis chez les adultes présentant une cardiopathie congénitale. L’utilisation concomitante du tabac et du cannabis avait les effets les plus préjudiciables sur les résultats rapportés par les patients.
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      Linked Article

      • ADHD Symptoms as a Potential Driver to Cannabis Use in Young Persons With Complex Congenital Heart Defects
        Canadian Journal of CardiologyVol. 35Issue 12
        • Preview
          Adequate health behaviours are a prerequisite for good long-term functioning and longevity. In the recent article titled “Prevalence and effects of cigarette smoking, cannabis consumption, and co-use in adults with congenital heart disease from 15 countries,” Moons et al. provided unique data from a large-scale international study in adults with congenital heart disease (CHD).1 Intriguingly, they found that male patients with complex and moderately complex CHD use cannabis more frequently than counterparts with mild CHD.
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