Acrolein and other toxicant exposures in relation to cardiovascular disease among marijuana and tobacco smokers in a longitudinal cohort of HIV-positive and negative adults.

TitleAcrolein and other toxicant exposures in relation to cardiovascular disease among marijuana and tobacco smokers in a longitudinal cohort of HIV-positive and negative adults.
Publication TypeJournal Article
Year of Publication2021
AuthorsLorenz, DR, Misra, V, Chettimada, S, Uno, H, Wang, L, Blount, BC, De Jesús, VR, Gelman, BB, Morgello, S, Wolinsky, SM, Gabuzda, D
JournalEClinicalMedicine
Volume31
Pagination100697
Date Published2021 Jan
ISSN2589-5370
KeywordsCHARTER, External
Abstract

Background: Marijuana smoke contains some of the same toxicants present in tobacco smoke. Marijuana smoking is prevalent among HIV+ individuals, but few studies have characterized smoke-related toxicants or associated health outcomes in exclusive marijuana users.Methods: This longitudinal study included 245 participants over age 40 (76% HIV+). 33 plasma and 28 urine metabolites of nicotine, ∆-9-trans-tetrahydrocannabinol, polycyclic aromatic hydrocarbons, and volatile organic compounds were assayed by liquid or gas chromatography/mass spectrometry. Exposures and health outcomes were assessed from surveys and medical records.Findings: At baseline, 18% of participants were marijuana-only smokers, 20% tobacco-only smokers, and 24% dual marijuana-tobacco smokers (median (IQR) age 53 (47-60) years, 78% male, 54% white race). Marijuana smoking was independently associated with elevated plasma naphthalenes, 2-hydroxyfluorene sulfate, 4-vinylphenol sulfate, and o-cresol sulfate 0·05) and urine acrylonitrile and acrylamide metabolites (0·05), but levels were lower than those associated with tobacco smoking. Acrolein metabolite N-Acetyl-S-(3-hydroxypropyl)-l-cysteine (3HPMA) was significantly elevated in plasma and urine in tobacco-only and dual but not marijuana-only smokers, and correlated with nicotine metabolites (0·05). The highest tertile of 3HPMA was associated with increased cardiovascular disease diagnoses independent of tobacco smoking, traditional risk factors, and HIV status (odds ratio [95% CI] 3·34 [1·31-8·57];   0·012).Interpretation: Smoke-related toxicants, including acrylonitrile and acrylamide metabolites, are detectable in exclusive marijuana smokers, but exposures are lower compared with tobacco or dual smokers. Acrolein exposure is increased by tobacco smoking but not exclusive marijuana smoking in HIV+ and HIV- adults, and contributes to cardiovascular disease in tobacco smokers.Funding: U.S. NIH.

DOI10.1016/j.eclinm.2020.100697
Alternate JournalEClinicalMedicine
PubMed ID33554087
PubMed Central IDPMC7846668
Grant ListU24 MH100929 / MH / NIMH NIH HHS / United States
U24 MH100925 / MH / NIMH NIH HHS / United States
U24 MH100931 / MH / NIMH NIH HHS / United States
U24 MH100928 / MH / NIMH NIH HHS / United States
U01 AI035041 / AI / NIAID NIH HHS / United States
UL1 TR000424 / TR / NCATS NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
U01 AI035039 / AI / NIAID NIH HHS / United States
R01 DA046203 / DA / NIDA NIH HHS / United States
U01 AI035042 / AI / NIAID NIH HHS / United States
U01 AI035043 / AI / NIAID NIH HHS / United States
R01 DA040391 / DA / NIDA NIH HHS / United States
U24 MH100930 / MH / NIMH NIH HHS / United States
U01 AI035040 / AI / NIAID NIH HHS / United States