CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 176 AFRICA 13. Michaud L, Dureau P, Kerleroux B, et al. Development and validation of a predictive score for prolonged mechanical ventilation after cardiac surgery. J Cardiothorac Vasc Anesth 2022; 36(3): 825–832. 14. Flynn BC, He J, Richey M, et al. Early Extubation without ıncreased adverse events in high-risk cardiac surgical patients. Ann Thorac Surg 2019; 107(2): 453–459. 15. Brovman EY, Tolis G, Hirji S, et al. Association between early extubation and postoperative reintubation after elective cardiac surgery: a bi-institutional study. J Cardiothorac Vasc Anesth 2022; 36(5): 1258– 1264. 16. Hajjar LA, Almeida JP, Fukushima JT, et al. High lactate levels are predictors of major complications after cardiac surgery. J Thorac Cardiovasc Surg 2013; 146(2): 455–460. 17. Duval B, Besnard T, Mion S, et al. Intraoperative changes in blood lactate levels are associated with worse short-term outcomes after cardiac surgery with cardiopulmonary bypass. Perfusion 2019; 34(8): 640–650. 18. Govender P, Tosh W, Burt C, et al. Evaluation of ıncrease in ıntraoperative lactate level as a predictor of outcome in adults after cardiac surgery. J Cardiothorac Vasc Anesth 2020; 34(4): 877–884. 19. Evans AS, Levin MA, Lin HM, et al. Prognostic value of hyperlactatemia and lactate clearance after mitral valve surgery. J Cardiothorac Vasc Anesth 2018; 32(2): 636–643. 20. Youssefi P, Timbrell D, Valencia O, et al. Predictors of failure in fast-track cardiac surgery. J Cardiothorac Vasc Anesth 2015; 29(6): 1466–1471. Frequent cannabis use bumps up heart attack risk: US study American researchers have suggested that people who frequently smoke weed have a greater risk of heart attack and stroke, after their analysis of several years of surveys on increases in marijuana and cannabis consumption. The article, published in The Journal of the American Heart Association, analysed responses to the US Government’s annual survey on behavioural risk from 2016 to 2020 in which respondents answered various questions, including reporting their own health problems related to heart disease. About 4% of the respondents reported daily marijuana use, which the researchers suggested raised the chance of a heart attack by 25% and of a stroke by 42%. Among those who had never smoked tobacco, daily use was tied to a 49% higher risk of heart attack and a more than doubled risk of stroke, the study indicated. The New York Times reports that about three-quarters of the respondents said smoking was their main method of using weed. The other quarter consumed it by vaping, through edibles or drinking it. ‘Cannabis smoke releases the same toxins and particulate matter as tobacco,’ said the study’s first author, Abra Jeffers, a data analyst at Massachusetts General Hospital in Boston. She conducted the analysis during her post-doctoral fellowship at the University of California, San Francisco. The study is merely observational in its review of survey responses; it does not provide conclusive evidence that regular marijuana use causes heart disease. Even so, researchers and experts said they were concerned about its implications, especially as cannabis use has increased in recent years. Thirty-eight states have legalised medical use of marijuana and 24 have begun allowing recreational use. Dr Nora Volkow, director of the National Institute of Drug Abuse, said as cannabis consumption has risen, ‘there has also been an increase in the emergence of adverse health effects including addiction, respiratory problems, accidents, psychosis and cardiovascular events’. The US Drug Enforcement Administration is weighing up whether to follow the recommendations of a team of federal scientists at the Food and Drug Administration, which concluded last year that marijuana should be reclassified to a less restrictive category of controlled substances. They cited a lesser potential for abuse than other drugs have, as well as marijuana’s possible medical benefits. But the new article’s authors warned that frequent marijuana use ‘could be an important, unappreciated risk factor leading to many preventable deaths’. ‘This study demonstrates that smoking cannabis may be as harmful as smoking tobacco,’ said Dr Salomeh Keyhani, a professor of medicine at the University of California, San Francisco, and the study’s senior author. ‘Cannabis is being marketed to the public as a substance that is harmless and that might be good for you,’ Keyhani added. ‘I worry that we’re sleepwalking into a public health crisis. The progress on tobacco smoking might be undone.’ Heart disease is already the nation’s leading cause of death. The US Centres for Disease Control and Prevention said 695 000 Americans died in 2021 of cardiovascularrelated causes, such as coronary artery disease. Other surveys have documented the surge in consumption of marijuana. The percentage of Americans reporting marijuana use increased to 17% last year from 7% in 2013, according to a Gallup poll. A study published in August and financed by the National Institute of Drug Abuse offered more details on consumption by age. From 2012 to 2022, reported use among adults up to age 30 years increased to 44% from 28%, while daily use rose to 11% from 6%. Among those 35- to 50-year-olds, the continued on page 192…
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