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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Article info
Publication history
Published online: August 14, 2019
Accepted:
July 16,
2019
Received:
May 10,
2019
Footnotes
Registration: ClinicalTrials.gov: NCT02150603.
See page 1849 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- ADHD Symptoms as a Potential Driver to Cannabis Use in Young Persons With Complex Congenital Heart DefectsCanadian Journal of CardiologyVol. 35Issue 12
- PreviewAdequate 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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