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Ibn Hadj Amor H, Touil I, Boukriba S, Bouchnak S, Kraiem S, Rouabhia R. Case Report: Spontaneous simultaneous coronary and carotid dissection in a young cannabis user. F1000Res 2021; 10:387. [PMID: 34164116 PMCID: PMC8204189 DOI: 10.12688/f1000research.52606.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/20/2022] Open
Abstract
Due to legalization of its consumption in some countries and its medical use as well as low toxic potential, cannabis remains the most widely used drug around the world and the rate of usage is only increasing. Nevertheless, there are several case reports of vascular complications following cannabis use even in young people without cardiovascular risk factors. We report the case of a cannabis smoker presenting to the emergency room for an ischemic stroke associated with an acute coronary syndrome related to a spontaneous simultaneous double dissection of the carotid artery and the left anterior descending artery, with a favourable outcome under medical treatment. This case shows the seriousness of complications due to the cannabis consumption, hence the need to limit or even prohibit its consumption.
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Affiliation(s)
| | - Imen Touil
- Pneumology Department, Taher Sfar university hospital, Mahdia, 5100, Tunisia
| | - Seif Boukriba
- Radiology Department, Rabta University Hospital, Tunis, 1007, Tunisia
| | - Skander Bouchnak
- Cardiology Department, Taher Sfar university hospital, Mahdia, 5100, Tunisia
| | - Salma Kraiem
- Cardiology Department, Taher Sfar university hospital, Mahdia, 5100, Tunisia
| | - Ramzi Rouabhia
- Cardiology Department, Taher Sfar university hospital, Mahdia, 5100, Tunisia
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Pereira MM, Mansur ADP, Takada JY, Leyton V. Demographic and Cardiovascular Risk Factors Associated with Drug Use in Truck Drivers in the State of São Paulo, Brazil: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094927. [PMID: 34066305 PMCID: PMC8124373 DOI: 10.3390/ijerph18094927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022]
Abstract
The aim of the study is to analyze the association between risk factors for the health of truck drivers and previous use of illicit drugs. A cross-sectional study examined the data from 2071 truck drivers between 2010 and 2016. Demographic variables, risk factors for cardiovascular disease (CVD) and the use of illicit drugs were analyzed. The stepwise logistic regression model was used for the adjusted analysis. The dependent variable was the previous use of illicit drugs, and independent variables were those with p < 0.1 at a bivariate analysis. The average age of the truck drivers was 42.27 ± 11.07 years, and the previous use of illicit drugs was reported or detected in 388 (18.7%) drivers. Compared to non-users, drug users were younger (37.25 ± 9.45 vs. 43.43 ± 11.1 years; p < 0.001) and single (43.3% vs. 28.4%; p < 0.001). The independent variables for illicit drugs were age (OR = 0.93 (95% CI: 0.91-0.95; p < 0.001)), smoking (OR = 2.18 (95% CI: 1.39-3.44; p = 0.001)), alcohol consumption (OR = 1.626 (95% CI: 1.06-2.49; p = 0.026)) and driving hours per day (OR = 1.08 (95% CI: 1.01-1.15; p = 0.012)). Users of illicit drugs had multiple risk factors for CVD and traffic accidents.
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Affiliation(s)
- Mariana Moura Pereira
- Oscar Freire Institute, University of Sao Paulo Medical School, São Paulo 05405-150, Brazil; (M.M.P.); (V.L.)
| | - Antonio de Padua Mansur
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo 05403-000, Brazil;
- Correspondence: ; Tel.: +55-11-98536-3040
| | - Julio Yoshio Takada
- Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo 05403-000, Brazil;
| | - Vilma Leyton
- Oscar Freire Institute, University of Sao Paulo Medical School, São Paulo 05405-150, Brazil; (M.M.P.); (V.L.)
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53
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Shah S, Patel S, Paulraj S, Chaudhuri D. Association of Marijuana Use and Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Data Analysis of 133,706 US Adults. Am J Med 2021; 134:614-620.e1. [PMID: 33181103 DOI: 10.1016/j.amjmed.2020.10.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Marijuana is the most commonly used psychoactive drug, while its effects on cardiovascular health are not well known and remain a subject of interest. METHODS We used the pooled 2016-2018 data from the Behavioral Risk Factor Surveillance System to perform a cross-sectional analysis evaluating the association of marijuana and cardiovascular disease among US adults who never smoked cigarettes. RESULTS Among US adults ages 18-74 years, when compared with nonusers, frequent marijuana use was associated with 88% higher odds of myocardial infarction or coronary artery disease (adjusted odds ratio [aOR] 1.88; 95% confidence interval [CI], 1.15-3.08), and 81% higher odds of stroke (aOR 1.81; 95% CI, 1.14-2.89). Among the premature cardiovascular disease group, frequent marijuana users had 2.3 times higher odds of myocardial infarction or coronary artery disease (aOR 2.27; 95% CI, 1.20-4.30), and 1.9 times higher odds of stroke (aOR 1.92; 95% CI, 1.07-3.43). In terms of the modality of marijuana use, frequent marijuana smoking had 2.1 times higher odds of myocardial infarction or coronary artery disease (aOR 2.07; 95% CI, 1.21-3.56), and 1.8 times higher odds of stroke (aOR 1.84; 95% CI, 1.09-3.10). A similar association was observed in the premature cardiovascular disease group who smoked marijuana (aOR [for myocardial infarction or coronary artery disease] 2.64; 95% CI, 1.37-5.09; aOR [for stroke] 2.00; 95% CI, 1.05-3.79). No association was observed between marijuana use in any form other than smoking and cardiovascular disease, across all age groups. CONCLUSION Frequent marijuana smoking is associated with significantly higher odds of stroke and myocardial infarction or coronary artery disease, with a possible role in premature cardiovascular disease.
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Affiliation(s)
- Siddharth Shah
- Division of Cardiology, State University of New York Upstate Medical University, Syracuse.
| | - Siddharth Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham
| | | | - Debanik Chaudhuri
- Division of Cardiology, State University of New York Upstate Medical University, Syracuse
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Bougrine R, Boutaybi M, Boulouiz S, Elouafi N, Bazid Z. Severe Myocardial Infarction Caused by Excessive Cannabis Consumption. Cureus 2021; 13:e14643. [PMID: 33903847 PMCID: PMC8064037 DOI: 10.7759/cureus.14643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The cardiovascular effects of cannabis are not well known. Cannabis use has been shown to cause arrhythmia, including ventricular tachycardia, sudden death, and increase in the risk of myocardial infarction (MI). We report a 62-year-old woman with chronic cannabis abuse inducing MI complicated by cardiogenic shock, chronic dilated cardiomyopathy, and atrial fibrillation.
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Affiliation(s)
- Ramia Bougrine
- Cardiology, Mohammed I University/Mohammed VI University Hospital, Oujda, MAR
| | - Mohamed Boutaybi
- Cardiology, Mohammed I University/Mohammed VI University Hospital, Oujda, MAR
| | - Soumia Boulouiz
- Cardiology, Mohammed I University/Mohammed VI University Hospital, Oujda, MAR
| | - Noha Elouafi
- Cardiology, Mohammed I University/Mohammed VI University Hospital, Oujda, MAR
| | - Zakaria Bazid
- Cardiology, Mohammed I University/Mohammed VI University Hospital/Epidemiological Laboratory of Clinical Research and Public Health, Oujda, MAR
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Nguyen S, Mangubat M, Eleswarapu S, Wilson JB, Molina J, Abraham A, Artaza JN, Friedman TC, Ferrini MG. The Combination of High-Fat Diet and Oral Marijuana Promotes the Development of Fibrosis in the Mouse Corpora Cavernosa. Sex Med 2021; 9:100312. [PMID: 33540365 PMCID: PMC8072182 DOI: 10.1016/j.esxm.2020.100312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The link between cannabis use and erectile dysfunction remains unclear. Moreover, the effect of cannabis in tandem with current Western dietary habits is an area in male sexual health that has yet to be explored. This study seeks to investigate the impact of diet and cannabis on penile health in an animal model. AIM To determine the effects of diet and oral cannabis extract on fibrosis and oxidative stress within the corpora cavernosa of mice. METHODS This is a pilot animal study in which groups of 2-month old C57BL/6J male mice were fed a normal chow diet (NCD) or high-fat diet (HFD) daily and treated with or without either MJ or THC extract for 2 months. After euthanization, mouse penises were isolated and processed for immunohistochemical studies to determine: (i) smooth muscle cell to collagen content, (ii) myofibroblast proliferation, and (iii) anti-oxidative activity. MAIN OUTCOME MEASURES Quantitative assessment of immunohistochemical markers of fibrosis and oxidative stress within the corpora cavernosa of mice fed a high-fat diet in combination with either oral marijuana (MJ) or Δ-9-tetrahydrocannabinol extract (THC). RESULTS The combination of HFD with MJ resulted in: (i) a decrease in the smooth/collagen ratio in the corpora cavernosa, (ii) an increase in alpha-smooth muscle actin expression in the tunica albuginea compatible with myofibroblast proliferation, and (iii) a decrease in heme oxygenase 1 expression indicating an increase in oxidative stress. Significant histological changes were not observed in the HFD + THC group. CONCLUSIONS HFD combined with oral MJ extract led to structural alterations in erectile tissue that are associated with accelerated corporal fibrosis. However, the addition of THC to the diet did not exacerbate histological changes within the corpora. Further studies are warranted to elucidate the discrepant effects between MJ and THC in order to optimize the therapeutic potential of cannabis and minimize its adverse effects on penile health. S Nguyen, M Mangubat, S Eleswarapu, et al. The Combination of High-Fat Diet and Oral Marijuana Promotes the Development of Fibrosis in the Mouse Corpora Cavernosa. Sex Med 2021;9:100312.
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Affiliation(s)
- Sabine Nguyen
- Department of Health and Life Sciences, Charles R. Drew University of Medicine and Science Los Angeles, CA, USA
| | - Michael Mangubat
- Department of Health and Life Sciences, Charles R. Drew University of Medicine and Science Los Angeles, CA, USA
| | - Sriram Eleswarapu
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julian B Wilson
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science Los Angeles, CA, USA
| | - Jocelyn Molina
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science Los Angeles, CA, USA
| | - Andrea Abraham
- Department of Health and Life Sciences, Charles R. Drew University of Medicine and Science Los Angeles, CA, USA
| | - Jorge N Artaza
- Department of Health and Life Sciences, Charles R. Drew University of Medicine and Science Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Theodore C Friedman
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Monica G Ferrini
- Department of Health and Life Sciences, Charles R. Drew University of Medicine and Science Los Angeles, CA, USA; Department of Internal Medicine, Charles R. Drew University of Medicine and Science Los Angeles, CA, USA.
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Duncan C, Butler K, Loa L. Cannabis use disorder: Implications and best practices. Nurse Pract 2021; 46:12-15. [PMID: 33606454 DOI: 10.1097/01.npr.0000733712.67456.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The legalization of recreational marijuana in some countries has been accompanied by an increased number of case reports of serious cardiovascular and cerebrovascular complications. However, there have been few studies describing the detailed clinical course of reversible cerebral vasospasm syndrome (RCVS) associated with marijuana use. We herein report a unique case of recurrent bi-fronto-parietal subcortical (watershed) infarction in the setting of chronic daily marijuana use for several years, with evidence of bilateral anterior cerebral artery vasoconstriction. The quick resolution of symptoms with treatment and the normalization of cerebral vasoconstriction on follow-up imaging lend high certainty to the diagnosis of RCVS.
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Affiliation(s)
- Takahisa Mikami
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, USA
- Department of Neurology, Tufts Medical Center, USA
| | - Reiichiro Obata
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, USA
| | - Daniel I Steinberg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, USA
| | - Maryna Skliut
- Department of Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, USA
| | - Irene Boniece
- Department of Neurology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, USA
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58
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Mahtta D, Ramsey D, Krittanawong C, Al Rifai M, Khurram N, Samad Z, Jneid H, Ballantyne C, Petersen LA, Virani SS. Recreational substance use among patients with premature atherosclerotic cardiovascular disease. Heart 2021; 107:650-656. [PMID: 33589427 DOI: 10.1136/heartjnl-2020-318119] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Despite an upsurge in the incidence of atherosclerotic cardiovascular diseases (ASCVD) among young adults, the attributable risk of recreational substance use among young patients has been incompletely evaluated. We evaluated the association of all recreational substances with premature and extremely premature ASCVD. METHODS In a cross-sectional analysis using the 2014-2015 nationwide Veterans Affairs Healthcare database and the Veterans wIth premaTure AtheroscLerosis (VITAL) registry, patients were categorised as having premature, extremely premature or non-premature ASCVD. Premature ASCVD was defined as having first ASCVD event at age <55 years for men and <65 years for women. Extremely premature was defined as having first ASCVD event at age <40 years while non-premature ASCVD was defined as having first ASCVD event at age ≥55 years for men and ≥65 years for women. Patients with premature ASCVD (n=135 703) and those with extremely premature ASCVD (n=7716) were compared against patients with non-premature ASCVD (n=1 112 455). Multivariable logistic regression models were used to study the independent association of all recreational substances with premature and extremely premature ASCVD. RESULTS Compared with patients with non-premature ASCVD, patients with premature ASCVD had a higher use of tobacco (62.9% vs 40.6%), alcohol (31.8% vs 14.8%), cocaine (12.9% vs 2.5%), amphetamine (2.9% vs 0.5%) and cannabis (12.5% vs 2.7%) (p<0.01 for all comparisons). In adjusted models, the use of tobacco (OR 1.97, 95% CI 1.94 to 2.00), alcohol (OR 1.50, 95% CI 1.47 to 1.52), cocaine (OR 2.44, 95% CI 2.38 to 2.50), amphetamine (OR 2.74, 95% CI 2.62 to 2.87), cannabis (OR 2.65, 95% CI 2.59 to 2.71) and other drugs (OR 2.53, 95% CI 2.47 to 2.59) was independently associated with premature ASCVD. Patients with polysubstance use had a graded response with the highest risk (~9-fold) of premature ASCVD among patients with use of ≥4 recreational substances. Similar trends were observed among patients with extremely premature ASCVD. Gender interactions with substance use were significant (p-interaction <0.05), with recreational substance use and premature ASCVD showing stronger associations among women than in men with premature ASCVD. CONCLUSIONS All subgroups of recreational substances were independently associated with a higher likelihood of premature and extremely premature ASCVD. Recreational substance use confers a greater magnitude of risk for premature ASCVD among women. A graded response relationship exists between increasing number of recreational substances used and higher likelihood of early-onset ASCVD.
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Affiliation(s)
- Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA.,Section of Cardiology, Department of Medicine, -Baylor College of Medicine, Houston, Texas, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David Ramsey
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA
| | - Chayakrit Krittanawong
- Section of Cardiology, Department of Medicine, -Baylor College of Medicine, Houston, Texas, USA
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, -Baylor College of Medicine, Houston, Texas, USA
| | - Nasir Khurram
- Division of Cardiovascular Medicine, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Zainab Samad
- Department of Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Hani Jneid
- Section of Cardiology, Department of Medicine, -Baylor College of Medicine, Houston, Texas, USA.,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Christie Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Laura A Petersen
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA .,Section of Cardiology, Department of Medicine, -Baylor College of Medicine, Houston, Texas, USA.,Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Pasha AK, Clements CY, Reynolds CA, Lopez MK, Lugo CA, Gonzalez Y, Shirazi FM, Abidov A. Cardiovascular Effects of Medical Marijuana: A Systematic Review. Am J Med 2021; 134:182-193. [PMID: 33186596 DOI: 10.1016/j.amjmed.2020.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022]
Abstract
Utilization of marijuana as a medicinal agent is becoming increasingly popular, and so far, 25 states have legalized it for medical purposes. However, there is emerging evidence that marijuana use can result in cardiovascular side effects, such as rhythm abnormalities, syncope/dizziness, and myocardial infarction, among others. Further, there are currently no stringent national standards or approval processes, like Food and Drug Administration (FDA) evaluation, in place to assess medical marijuana products. This review includes the largest up-to-date pooled population of patients with exposure to marijuana and reported cardiovascular effects. Although purported as benign by many seeking to advance the use of marijuana as an adjunctive medical therapy across the country, marijuana is associated with its own set of cardiovascular risks and deserves further definitive study and the same level of scrutiny we apply in research of all other types of medications. When used as a medicinal agent, marijuana should be regarded accordingly, and both clinical providers and patients must be aware of potential adverse effects associated with its use for early recognition and management.
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Affiliation(s)
- Ahmed K Pasha
- Hospital Internal Medicine, Mayo Clinic Health System, Mankato, Minn
| | | | | | | | | | | | - Farshad M Shirazi
- Arizona Poison and Drug Information Center, University of Arizona, Tucson
| | - Aiden Abidov
- Cardiology Section, John D. Dingell VA Medical Center, Detroit, Mich.
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Mosaed S, Liu JHK, Minckler DS, Fitzgerald RL, Grelotti D, Sones E, Shiels CR, Weinreb RN, Marcotte TD. The Effect of Inhaled Cannabis on Intraocular Pressure in Healthy Adult Subjects. Ophthalmology 2021. [DOI: 10.17925/opht.2021.15.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chetty K, Lavoie A, Deghani P. A Literature Review of Cannabis and Myocardial Infarction-What Clinicians May Not Be Aware Of. CJC Open 2021; 3:12-21. [PMID: 33458628 PMCID: PMC7801213 DOI: 10.1016/j.cjco.2020.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Increasing legalization and expanding medicinal use have led to a significant rise in global cannabis consumption. With this development, we have seen a growing number of case reports describing adverse cardiovascular events, specifically, cannabis-induced myocardial infarction (MI). However, there are considerable knowledge gaps on this topic among health care providers. This review aims to provide an up-to-date review of the current literature, as well as practical recommendations for clinicians. We also focus on proposed mechanisms implicating cannabis as a risk factor for MI. We performed a comprehensive literature search using the MEDLINE, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Turning Research into Practice (TRIP) PRO databases for articles published between 2000 and 2018. A total of 92 articles were included. We found a significant number of reports describing cannabis-induced MI. This was especially prevalent among young healthy patients, presenting shortly after use. The most commonly proposed mechanisms included increased autonomic stimulation, altered platelet function, vasospasm, and direct toxic effects of smoke constituents. However, it is likely that the true pathogenesis is multifactorial. We should increase our pretest probability for MI in young patients presenting with chest pain. We also recommend against cannabis use in patients with known coronary artery disease, especially if they have stable angina. Finally, if patients are adamant about using cannabis, health care providers should recommend against smoking cannabis, avoidance of concomitant tobacco use, and use of the lowest delta-9-tetrahydrocannabinol dose possible. Data quality is limited to that of observational studies and case report data. Therefore, more clinical trials are needed to determine a definitive cause-and-effect relationship.
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Affiliation(s)
| | - Andrea Lavoie
- Department of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Payam Deghani
- Department of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Meera SJ, Vallabhaneni S, Shirani J. Cannabis-induced basal-mid-left ventricular stress cardiomyopathy: A case report. Int J Crit Illn Inj Sci 2020; 10:49-52. [PMID: 33376691 PMCID: PMC7759071 DOI: 10.4103/ijciis.ijciis_25_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/05/2020] [Accepted: 06/09/2020] [Indexed: 11/04/2022] Open
Abstract
Cannabis, popularly known as marijuana, is a recreational drug derived from the plant Cannabis Sativa. It has been recognized as the most widely used mood-altering substance in the world and is falsely perceived as a safe substance by the public at large. This is mostly due to lack of awareness of its adverse effects as well as successful attempts for legalization of its use in many states. We present a unique case of a 56-year-old man who presented with neurological deficits concerning for stroke. Soon after presentation, he required endotracheal intubation for airway protection due to worsening mental status changes and pulmonary edema. Echocardiogram revealed severe hypokinesis of the basal and mid-left ventricular (LV) walls with hyperdynamic motion of the apex (reverse takotsubo). Coronary angiography revealed no obstructive disease. Urine toxicology screen was positive for Δ-9-tetrahydrocannabinol. The patient then stated to have used excess marijuana before the symptom onset, while denying any recent emotional stressors. The findings were consistent with stress cardiomyopathy (SC) triggered by marijuana use. Myocardial infarction, stroke, and peripheral arteriopathy have been increasingly reported in younger individuals using marijuana. SC appears to be another unique complication of marijuana use triggered through its effects on the autonomic nervous and endocannabinoid systems.
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Affiliation(s)
- Srinidhi J Meera
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | | | - Jamshid Shirani
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
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Banerjee A, Gandhi AB, Antony I, Alexander J, Hisbulla M, Kannichamy V, Kaleem I, Mishra V, Khan S. Role of Cannabis in the Incidence of Myocardial Infarction: A Review. Cureus 2020; 12:e11097. [PMID: 33240693 PMCID: PMC7681753 DOI: 10.7759/cureus.11097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Legalizing cannabis use in various states in the United States has caused increased substance abuse, mostly among young people. There are very little data focussing on marijuana use and myocardial infarction (MI) incidence. The objective of the study is to analyze the published papers for cannabis-induced MI and derive a strong relation between cannabis use and MI and understand the pathophysiology. An online search was conducted in PubMed, Google Scholar, and PubMed Central to find relevant publications examining patients who developed MI due to cannabis use. Out of 32 articles that were identified for this review, 17 are case reports, one is a letter to the editor, eight are observational studies, and six are review articles. Many studies have proposed different mechanisms by which cannabis affects the body. Our study shows that marijuana can precipitate MI even if it is used for the first time. Limited data is available to comment on the mortality of patients after cannabis-induced MI. These findings highlight the necessity for public awareness to prevent the ill-effects of cannabis, especially for teenagers and older people.
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Affiliation(s)
- Amit Banerjee
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Arohi B Gandhi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ishan Antony
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Josh Alexander
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mohamed Hisbulla
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vishmita Kannichamy
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ifrah Kaleem
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vinayak Mishra
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Navarrete C, Garcia-Martin A, DeMesa J, Muñoz E. Cannabinoids in Metabolic Syndrome and Cardiac Fibrosis. Curr Hypertens Rep 2020; 22:98. [PMID: 33089434 DOI: 10.1007/s11906-020-01112-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This article provides a concise overview of how cannabinoids and the endocannabinoid system (ECS) have significant implications for the prevention and treatment of metabolic syndrome (MetS) and for the treatment of cardiovascular disorders, including cardiac fibrosis. RECENT FINDINGS Over the past few years, the ECS has emerged as a pivotal component of the homeostatic mechanisms for the regulation of many bodily functions, including inflammation, digestion, and energy metabolism. Therefore, the pharmacological modulation of the ECS by cannabinoids represents a novel strategy for the management of many diseases. Specifically, increasing evidence from preclinical research studies has opened new avenues for the development of cannabinoid-based therapies for the management and potential treatment of MetS and cardiovascular diseases. Current information indicates that modulation of the ECS can help maintain overall health and well-being due to its homeostatic function. From a therapeutic perspective, cannabinoids and the ECS have also been shown to play a key role in modulating pathophysiological states such as inflammatory, neurodegenerative, gastrointestinal, metabolic, and cardiovascular diseases, as well as cancer and pain. Thus, targeting and modulating the ECS with cannabinoids or cannabinoid derivatives may represent a major disease-modifying medical advancement to achieve successful treatment for MetS and certain cardiovascular diseases.
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Affiliation(s)
| | | | - Jim DeMesa
- Emerald Health Pharmaceuticals, San Diego, CA, USA
| | - Eduardo Muñoz
- Instituto Maimónides de Investigación Biomédica de Córdoba, University of Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.
- Departamento de Biologia Celular, Fisiologia e Inmunologia, Universidad de Córdoba, Córdoba, Spain.
- Hospital Universitario Reina Sofia, Córdoba, Spain.
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Adamson M, Di Giovanni B, Delgado DH. The positive and negative cardiovascular effects of cannabis. Expert Rev Cardiovasc Ther 2020; 18:905-917. [PMID: 33054426 DOI: 10.1080/14779072.2020.1837625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The use of cannabis and its derivatives have increased steadily over the past few decades, prompting patients and clinicians to increasingly inquire about its health effects and safety profile. However, despite promising evidence suggesting therapeutic utilization, cannabis remains a controlled substance in most countries and is largely considered to have no medical or recreational benefit; thus, a lack of observational studies and randomized control trials exist to outline positive and negative health implications. Ultimately, this leaves patients, health-care professionals, and policymakers without necessary evidence required to make informed decisions on cannabis use. AREAS COVERED This review outlines cannabis in a clinical setting and delves into specific effects of cannabinoids on cardiovascular health and disease. It discusses positive and negative health implications associated with cannabis, mechanisms in cardiovascular disease, and reveals methods guiding cannabis use in the clinical setting. EXPERT OPINION Advances in research are necessary to guide decisions regarding cannabinoid use. Countries that have federally legalized cannabis have a unique opportunity to study cardiovascular implications in an unbiased and comprehensive manner. Ultimately, as cannabis use will inevitably increase, researchers, clinicians, and policymakers must work together to ensure cannabis is utilized in a way that is therapeutically beneficial.
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Affiliation(s)
- Mitchell Adamson
- Department of Medicine, Institute of Medical Sciences, University of Toronto , Toronto, ON, Canada.,Division of Cardiology, Heart Failure and Transplant Program, Toronto General Hospital, University Health Network , Toronto, ON, Canada
| | - Bennett Di Giovanni
- Division of Cardiology, Heart Failure and Transplant Program, Toronto General Hospital, University Health Network , Toronto, ON, Canada
| | - Diego H Delgado
- Division of Cardiology, Heart Failure and Transplant Program, Toronto General Hospital, University Health Network , Toronto, ON, Canada
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66
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Gupta A, Haritha D, Sinha R. Persistent intraoperative arrhythmias due to cannabis: Report of two cases. Indian J Anaesth 2020; 64:S210-S212. [PMID: 33162605 PMCID: PMC7641057 DOI: 10.4103/ija.ija_324_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Anju Gupta
- Department of Anesthesiology, Pain and Critical Care, AIIMS, New Delhi, India
| | - Damarla Haritha
- Department of Anesthesiology, Pain and Critical Care, AIIMS, New Delhi, India
| | - Renu Sinha
- Department of Anesthesiology, Pain and Critical Care, AIIMS, New Delhi, India
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67
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DeFilippis EM, Bajaj NS, Singh A, Malloy R, Givertz MM, Blankstein R, Bhatt DL, Vaduganathan M. Marijuana Use in Patients With Cardiovascular Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 75:320-332. [PMID: 31976871 PMCID: PMC7977484 DOI: 10.1016/j.jacc.2019.11.025] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Abstract
Marijuana use is increasing as more states are legalizing cannabis for both medicinal and recreational purposes. National survey data estimate that >2 million Americans with established cardiovascular diseases currently use or have used marijuana in its variety of forms, including inhalation and vaping. Cannabinoid receptors are distributed in multiple tissue beds and cells, including platelets, adipose tissue, and myocytes. Observational data suggest associations between marijuana and a broad range of adverse cardiovascular risks. Marijuana is becoming increasingly potent, and smoking marijuana carries many of the same cardiovascular health hazards as smoking tobacco. Synthetic cannabinoids have been linked to more sustained and deleterious pharmacodynamic effects. Marijuana is classified as a Schedule I substance, thus limiting its rigorous study for cardiovascular health effects. This review summarizes cardiovascular considerations related to marijuana use, pharmacological interactions, and future steps to provide clearer guidance regarding its cardiovascular safety. Screening for marijuana use is encouraged, especially in young patients presenting with cardiovascular disease.
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Affiliation(s)
- Ersilia M DeFilippis
- Columbia University Irving Medical Center, New York, New York. https://twitter.com/ersied727
| | - Navkaranbir S Bajaj
- University of Alabama at Birmingham, Birmingham, Alabama. https://twitter.com/bajaj_nav
| | - Amitoj Singh
- Sarver Heart Center, University of Arizona, Tucson, Arizona
| | - Rhynn Malloy
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Michael M Givertz
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Ron Blankstein
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts. https://twitter.com/RonBlankstein
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts. https://twitter.com/DLBHATTMD
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts.
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Mahtta D, Khalid U, Misra A, Samad Z, Nasir K, Virani SS. Premature Atherosclerotic Cardiovascular Disease: What Have We Learned Recently? Curr Atheroscler Rep 2020; 22:44. [PMID: 32671484 DOI: 10.1007/s11883-020-00862-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW In contrast to patients with non-premature atherosclerotic cardiovascular disease (ASCVD), patients with premature ASCVD have not observed a similar decline in cardiovascular mortality and recurrent adverse events. We sought to review the underlying risk factors, potential gaps in medical management, associated outcomes, and tools for risk prognostication among patients with premature ASCVD. RECENT FINDINGS In addition to traditional cardiovascular risk factors (i.e., diabetes, familial hypercholesterolemia), non-traditional risk factors such as chronic inflammatory conditions, recreational drug use, genetics, and pregnancy-related complications play a key role in development and progression of premature ASCVD. Patients with premature ASCVD, and especially women, receive less optimal medical management as compared to their non-premature counterparts. There is an increasing prevalence of cardiovascular risk factors among young adults. Hence, this population remains at an elevated risk for premature ASCVD and subsequent adverse cardiovascular events. Future studies evaluating different risk assessment tools and focusing on young patients across all three major domains of ASCVD are needed.
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Affiliation(s)
- Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA.,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Umair Khalid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Arunima Misra
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Zainab Samad
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Khurram Nasir
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA. .,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. .,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
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69
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Richards JR. Mechanisms for the Risk of Acute Coronary Syndrome and Arrhythmia Associated With Phytogenic and Synthetic Cannabinoid Use. J Cardiovasc Pharmacol Ther 2020; 25:508-522. [PMID: 32588641 DOI: 10.1177/1074248420935743] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Phytogenic cannabinoids from Cannabis sativa and synthetic cannabinoids are commonly used substances for their recreational and medicinal properties. There are increasing reports of cardiotoxicity in close temporal association with cannabinoid use in patients with structurally normal hearts and absence of coronary arterial disease. Associated adverse events include myocardial ischemia, conduction abnormalities, arrhythmias, and sudden death. This review details the effects of phytogenic and synthetic cannabinoids on diverse receptors based on evidence from in vitro, human, and animal studies to establish a molecular basis for these deleterious clinical effects. The synergism between endocannabinoid dysregulation, cannabinoid receptor, and noncannabinoid receptor binding, and impact on cellular ion flux and coronary microvascular circulation is delineated. Pharmacogenetic factors placing certain patients at higher risk for cardiotoxicity are also correlated with the diverse effects of cannabinoids.
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Affiliation(s)
- John R Richards
- Department of Emergency Medicine, 70083University of California Davis Medical Center, Sacramento, California, CA, USA
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The Impact of Marijuana on the Cardiovascular System: A Review of the Most Common Cardiovascular Events Associated with Marijuana Use. J Clin Med 2020; 9:jcm9061925. [PMID: 32575540 PMCID: PMC7355963 DOI: 10.3390/jcm9061925] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/01/2020] [Accepted: 06/16/2020] [Indexed: 02/03/2023] Open
Abstract
With the expanded legalization of marijuana, its medical and recreational use have sharply increased over the past decade. A wide array of new forms of cannabis is available on the market today, and the potencies are ten times those of forms previously tested, meaning that the true impact of marijuana on the cardiovascular system remains unclear. Cannabis mainly exerts its effects via the sympathetic and parasympathetic nervous systems, with different doses affecting different cannabinoids receptors. Studies have shown that marijuana plays a role in thrombosis, inflammation, and atherosclerosis. Case reports have linked marijuana use to myocardial infarction, cardiac arrythmias, cardiomyopathies, stroke, and arteritis. Most patients are young, healthy men with no cardiovascular risk factors; however, the patient population is expected to change to include older individuals in the future. The widespread public perception of safety accompanying marijuana use has contributed to its increased use among the elderly, who are the most at risk population for acute cardiovascular events. In this review, we aim to provide a basic understanding of the physiological effects of marijuana on the cardiovascular system and to review the current literature regarding cardiovascular diseases linked to marijuana use in adults.
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71
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Guler EM, Bektay MY, Akyildiz AG, Sisman BH, Izzettin FV, Kocyigit A. Investigation of DNA damage, oxidative stress, and inflammation in synthetic cannabinoid users. Hum Exp Toxicol 2020; 39:1454-1462. [PMID: 32508150 DOI: 10.1177/0960327120930057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The widespread use of synthetic cannabinoids (SCs) among youth has become an important public health problem. Several life-threatening side effects of SC have been reported, including cardiovascular, gastrointestinal, neurological, renal, metabolic, ophthalmologic, and pulmonary effects, besides skin toxicity and hepatotoxicity. METHODS Given that high levels of SC can lead to oxidative stress, DNA damage, and inflammation, it has been aimed in this study to investigate the effects of SC in aspects of primary DNA damage, plasma total oxidant status (TOS)/total antioxidant status (TAS), thiol-disulfide homeostasis, myeloperoxidase (MPO) level, and cytokine levels (interleukin 1 beta (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNF-α)) of 40 SC users (SCUs) in Turkey. RESULTS Mean plasma TOS levels were significantly higher in the SCUs group than in the healthy group (HG). Similarly, mononuclear leukocyte DNA damage, plasma TOS, MPO activity, disulfide, oxidative stress index levels, IL-1β, IL-6, and TNF-α levels were significantly higher in the SCU group than in the HG, whereas plasma TAS, total, and native thiol levels were significantly lower in the SCU group than in the HG. CONCLUSION It is concluded that SC can cause increase in oxidative stress and in inflammatory processes in addition to its potential for DNA damage. Additional studies with larger sample sizes and longer durations should be held to understand more specific outcomes of SC use.
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Affiliation(s)
- E M Guler
- Faculty of Medicine, Department of Medical Biochemistry, Bezmialem Vakif University, Istanbul, Turkey.,Traditional and Complementary Medicine, Advanced Research and Application Center, Bezmialem Vakif University, Istanbul, Turkey
| | - M Y Bektay
- Faculty of Pharmacy, Department of Clinical Pharmacy, Bezmialem Vakif University, Istanbul, Turkey.,Faculty of Pharmacy, Department of Clinical Pharmacy, Marmara University, Istanbul, Turkey
| | - A G Akyildiz
- Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Bezmialem Vakif University, Istanbul, Turkey.,Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Istanbul University, Istanbul, Turkey
| | - B H Sisman
- Department of Emergency Medicine, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - F V Izzettin
- Faculty of Pharmacy, Department of Clinical Pharmacy, Bezmialem Vakif University, Istanbul, Turkey
| | - A Kocyigit
- Faculty of Medicine, Department of Medical Biochemistry, Bezmialem Vakif University, Istanbul, Turkey.,Traditional and Complementary Medicine, Advanced Research and Application Center, Bezmialem Vakif University, Istanbul, Turkey
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Silver LD, Naprawa AZ, Padon AA. Assessment of Incorporation of Lessons From Tobacco Control in City and County Laws Regulating Legal Marijuana in California. JAMA Netw Open 2020; 3:e208393. [PMID: 32558915 PMCID: PMC7305525 DOI: 10.1001/jamanetworkopen.2020.8393] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE As marijuana continues to be legalized in many states, little is known about best regulatory practice, exposing the population to significant potential harm. OBJECTIVE To assess the extent to which potential best practices, including those from tobacco control, were incorporated into state and local marijuana policies in California. DESIGN AND SETTING California legalized medical marijuana in 1996 and adult recreational use in 2016, effective in January 2018. A cross-sectional study with data collection and analysis from February 1 to November 30, 2019, measured the adoption of potential demand reduction and youth protection best practices, including restrictions on sales, products, marketing, warnings, and taxation. Laws in effect by January 31, 2019, were verified and all 539 California local jurisdictions were studied. MAIN OUTCOMES AND MEASURES Adoption of potential best practices in marijuana laws for demand reduction and youth protection. RESULTS The laws of 534 of California's 539 jurisdictions (99%) were successfully identified; 263 of these 534 jurisdictions (49%) allowed any retail sale of marijuana, covering 57% of the state's population. More than one-third of jurisdictions allow sales of marijuana for adult recreational use (203 of 534 [38%]); of those, 122 allow storefront dispensaries and 81 allow sales by delivery only. A total of 257 of 534 jurisdictions (48%) allow medical sales. Of 147 jurisdictions allowing medical or adult use dispensaries, 93 (63%) limited the number of licenses, with a mean of 1 store for every 19 058 residents (range, 154-355 143). The state imposed no limits on number of dispensaries or deliverers. Forty-two jurisdictions increased the state-specified distances required between dispensaries and schools. Only 8 jurisdictions allowing retail sales imposed restrictions on products exceeding state regulations; 1 prohibited sale of flavored products, 3 prohibited sale of marijuana-infused beverages, and 5 imposed additional restrictions on edible marijuana products. No jurisdictions limited potency of products sold, although 1 established a potency-linked tax. The state did not limit or tax potency, except for establishing a standard 10-mg dose of tetrahydrocannabinol for edible marijuana products, nor did they limit manufacturing or sale of flavored products. The state required only a health warning in 6-point font on packages. Twenty-seven jurisdictions required additional health warnings in stores or on packages, 27 allowed onsite consumption of marijuana products, and 13 allowed marijuana-related events. More than half of jurisdictions legalizing any cannabis commerce (154 of 289 [53%]) did not tax marijuana locally and little revenue was captured for prevention. Much of the state excise and cultivation taxes is slated for youth substance use prevention and treatment. CONCLUSIONS AND RELEVANCE In implementing legalization of marijuana in California, local policies varied widely. Where marijuana was legalized, many lessons from tobacco control to reduce demand, limit harm, and prevent youth use were not adopted, potentially creating greater risk of harm.
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Farra YM, Eden MJ, Coleman JR, Kulkarni P, Ferris CF, Oakes JM, Bellini C. Acute neuroradiological, behavioral, and physiological effects of nose-only exposure to vaporized cannabis in C57BL/6 mice. Inhal Toxicol 2020; 32:200-217. [PMID: 32475185 DOI: 10.1080/08958378.2020.1767237] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: The rapid increase of cannabis consumption reinforces the need to elucidate the health hazards of this practice. The presence of fine particulate matter in cannabis smoke and vapor poses a major concern, as it may contribute to cardiopulmonary disease. To facilitate the assessment of risks associated with cannabis inhalation, we developed and characterized a method for exposing mice to cannabis in a way that mimics the delivery of the drug to the airways of smokers. Materials and Methods: Cannabis (10.3% THC, 0.05% CBD) was vaporized to generate aerosols with a reproducible particle profile. Aerosols were acutely delivered to male, adult C57BL/6 mice via a nose-only exposure system. Serum THC levels were measured for increasing cannabis doses. Blood pressure and heart rate were recorded at baseline and following exposure. Behavioral response to cannabis inhalation in the open field was documented. Awake neurological activity upon cannabis exposure was monitored using BOLD fMRI.Results and Discussion: Cannabis aerosols contained particles with count median diameter of 243 ± 39 nm and geometric standard deviation of 1.56 ± 0.06. Blood serum THC levels increased linearly with aerosolized mass and peaked at 136 ± 5 ng/mL. Cannabis inhalation decreased heart rate and blood pressure but promoted anxiety-like behavior. Observed differences in BOLD activation volumes linked cannabis to increased awareness to sensory stimuli and reduced behavioral arousal.Conclusions: Quantified physiological, behavioral, and neurological responses served as validation for our mouse model of cannabis inhalation. Animal models of aerosol exposure will be instrumental for uncovering the health outcomes of chronic cannabis use.
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Affiliation(s)
- Yasmeen M Farra
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Matthew J Eden
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - James R Coleman
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA, USA
| | - Praveen Kulkarni
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA, USA
| | - Craig F Ferris
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA, USA
| | - Jessica M Oakes
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Chiara Bellini
- Department of Bioengineering, Northeastern University, Boston, MA, USA
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74
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Wolfrom B, Ng VK. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:e140-e141. [PMID: 32404465 PMCID: PMC7219799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Brent Wolfrom
- Directeur du programme postdoctoral au Département de médecine familiale de l'Université Queen's à Kingston (Ontario), et observateur des soins de santé des anciens combattants pour le Groupe d'intérêt des membres sur la médecine du travail du Collège des médecins de famille du Canada.
| | - Victor K Ng
- Médecin conseiller auprès de la division Développement professionnel et Soutien à la pratique, et professeur adjoint en médecine familiale et d'urgence à l'Université de Toronto (Ontario) et à l'Université Western à London (Ontario)
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75
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Wolfrom B, Ng VK. Cannabis in the workplace: What physicians need to know. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:317-318. [PMID: 32404448 PMCID: PMC7219804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Brent Wolfrom
- Postgraduate Program Director in the Department of Family Medicine at Queen's University in Kingston, Ont, and Veterans' Health Observer for the Occupational Medicine Community of Practice of the College of Family Physicians of Canada.
| | - Victor K Ng
- Physician advisor in the Professional Development and Practice Support division of the College of Family Physicians of Canada and Assistant Professor in family and emergency medicine at the University of Toronto in Ontario and at Western University in London, Ont
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Osborne AJ, Pearson JF, Noble AJ, Gemmell NJ, Horwood LJ, Boden JM, Benton MC, Macartney-Coxson DP, Kennedy MA. Genome-wide DNA methylation analysis of heavy cannabis exposure in a New Zealand longitudinal cohort. Transl Psychiatry 2020; 10:114. [PMID: 32321915 PMCID: PMC7176736 DOI: 10.1038/s41398-020-0800-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/11/2020] [Accepted: 03/20/2020] [Indexed: 12/24/2022] Open
Abstract
Cannabis use is of increasing public health interest globally. Here we examined the effect of heavy cannabis use, with and without tobacco, on genome-wide DNA methylation in a longitudinal birth cohort (Christchurch Health and Development Study, CHDS). A total of 48 heavy cannabis users were selected from the CHDS cohort, on the basis of their adult exposure to cannabis and tobacco, and DNA methylation assessed from whole blood samples, collected at approximately age 28. Methylation in heavy cannabis users was assessed, relative to non-users (n = 48 controls) via the Illumina Infinium® MethylationEPIC BeadChip. We found the most differentially methylated sites in cannabis with tobacco users were in the AHRR and F2RL3 genes, replicating previous studies on the effects of tobacco. Cannabis-only users had no evidence of differential methylation in these genes, or at any other loci at the epigenome-wide significance level (P < 10-7). However, there were 521 sites differentially methylated at P < 0.001 which were enriched for genes involved in neuronal signalling (glutamatergic synapse and long-term potentiation) and cardiomyopathy. Further, the most differentially methylated loci were associated with genes with reported roles in brain function (e.g. TMEM190, MUC3L, CDC20 and SP9). We conclude that the effects of cannabis use on the mature human blood methylome differ from, and are less pronounced than, the effects of tobacco use, and that larger sample sizes are required to investigate this further.
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Affiliation(s)
- Amy J. Osborne
- grid.21006.350000 0001 2179 4063School of Biological Sciences, University of Canterbury, Christchurch, 8041 New Zealand
| | - John F. Pearson
- grid.29980.3a0000 0004 1936 7830Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, 8011 New Zealand
| | - Alexandra J. Noble
- grid.21006.350000 0001 2179 4063School of Biological Sciences, University of Canterbury, Christchurch, 8041 New Zealand
| | - Neil J. Gemmell
- grid.29980.3a0000 0004 1936 7830Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, 9054 New Zealand
| | - L. John Horwood
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago Christchurch, Christchurch, 8011 New Zealand
| | - Joseph M. Boden
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago Christchurch, Christchurch, 8011 New Zealand
| | - Miles C. Benton
- grid.419706.d0000 0001 2234 622XHuman Genomics, Institute of Environmental Science and Research, Kenepuru Science Centre, Porirua, 5240 New Zealand
| | - Donia P. Macartney-Coxson
- grid.419706.d0000 0001 2234 622XHuman Genomics, Institute of Environmental Science and Research, Kenepuru Science Centre, Porirua, 5240 New Zealand
| | - Martin A. Kennedy
- grid.29980.3a0000 0004 1936 7830Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, 8011 New Zealand
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Richards JR, Blohm E, Toles KA, Jarman AF, Ely DF, Elder JW. The association of cannabis use and cardiac dysrhythmias: a systematic review. Clin Toxicol (Phila) 2020; 58:861-869. [DOI: 10.1080/15563650.2020.1743847] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- John R. Richards
- Department of Emergency Medicine, University of California Davis Health System, Sacramento, CA, USA
| | - Eike Blohm
- Department of Emergency Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Kara A. Toles
- Department of Emergency Medicine, University of California Davis Health System, Sacramento, CA, USA
| | - Angela F. Jarman
- Department of Emergency Medicine, University of California Davis Health System, Sacramento, CA, USA
| | - Dylan F. Ely
- Department of Emergency Medicine, University of California Davis Health System, Sacramento, CA, USA
| | - Joshua W. Elder
- Department of Emergency Medicine, University of California Davis Health System, Sacramento, CA, USA
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Gonçalves ECD, Baldasso GM, Bicca MA, Paes RS, Capasso R, Dutra RC. Terpenoids, Cannabimimetic Ligands, beyond the Cannabis Plant. Molecules 2020; 25:E1567. [PMID: 32235333 PMCID: PMC7181184 DOI: 10.3390/molecules25071567] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023] Open
Abstract
Medicinal use of Cannabis sativa L. has an extensive history and it was essential in the discovery of phytocannabinoids, including the Cannabis major psychoactive compound-Δ9-tetrahydrocannabinol (Δ9-THC)-as well as the G-protein-coupled cannabinoid receptors (CBR), named cannabinoid receptor type-1 (CB1R) and cannabinoid receptor type-2 (CB2R), both part of the now known endocannabinoid system (ECS). Cannabinoids is a vast term that defines several compounds that have been characterized in three categories: (i) endogenous, (ii) synthetic, and (iii) phytocannabinoids, and are able to modulate the CBR and ECS. Particularly, phytocannabinoids are natural terpenoids or phenolic compounds derived from Cannabis sativa. However, these terpenoids and phenolic compounds can also be derived from other plants (non-cannabinoids) and still induce cannabinoid-like properties. Cannabimimetic ligands, beyond the Cannabis plant, can act as CBR agonists or antagonists, or ECS enzyme inhibitors, besides being able of playing a role in immune-mediated inflammatory and infectious diseases, neuroinflammatory, neurological, and neurodegenerative diseases, as well as in cancer, and autoimmunity by itself. In this review, we summarize and critically highlight past, present, and future progress on the understanding of the role of cannabinoid-like molecules, mainly terpenes, as prospective therapeutics for different pathological conditions.
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Affiliation(s)
- Elaine C. D. Gonçalves
- Laboratory of Autoimmunity and Immunopharmacology (LAIF), Department of Health Sciences, Campus Araranguá, Universidade Federal de Santa Catarina, Araranguá 88906-072, Brazil; (E.C.D.G.); (G.M.B.); (R.S.P.)
- Graduate Program of Neuroscience, Center of Biological Sciences, Campus Florianópolis, Universidade Federal de Santa Catarina, Florianópolis 88040-900, Brazil
| | - Gabriela M. Baldasso
- Laboratory of Autoimmunity and Immunopharmacology (LAIF), Department of Health Sciences, Campus Araranguá, Universidade Federal de Santa Catarina, Araranguá 88906-072, Brazil; (E.C.D.G.); (G.M.B.); (R.S.P.)
| | - Maíra A. Bicca
- Neurosurgery Department, Neurosurgery Pain Research institute, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA;
| | - Rodrigo S. Paes
- Laboratory of Autoimmunity and Immunopharmacology (LAIF), Department of Health Sciences, Campus Araranguá, Universidade Federal de Santa Catarina, Araranguá 88906-072, Brazil; (E.C.D.G.); (G.M.B.); (R.S.P.)
| | - Raffaele Capasso
- Department of Agricultural Sciences, University of Naples Federico II, 80,055 Portici, Italy
| | - Rafael C. Dutra
- Laboratory of Autoimmunity and Immunopharmacology (LAIF), Department of Health Sciences, Campus Araranguá, Universidade Federal de Santa Catarina, Araranguá 88906-072, Brazil; (E.C.D.G.); (G.M.B.); (R.S.P.)
- Graduate Program of Neuroscience, Center of Biological Sciences, Campus Florianópolis, Universidade Federal de Santa Catarina, Florianópolis 88040-900, Brazil
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Yerima MM, Onifade PO, Wakawa IA, Pindar SK, Jidda MS, Musami UB, Ali FA. Convergent Validity of Self-Administered Addiction Severity Index in a Sample of Nigerian Patients in a Residential Treatment Facility. Niger Med J 2020; 61:73-77. [PMID: 32675898 PMCID: PMC7357803 DOI: 10.4103/nmj.nmj_59_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/03/2019] [Accepted: 10/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Substance use disorders present with multiple drug-related problems that need to be evaluated with a view to planning and administering holistic interventions that could potentially improve addiction treatment outcomes. Many valid instruments are available for assessing the problems that occur in addiction but most of them require some training and they take a lot of time to administer. This study validates a shorter self-administered version of the Addiction severity Index (ASI) against the Clinician-administered ASI with a view to cutting the time needed to administer the instrument. METHODS The study recruited 142 patients in a residential treatment center. Correlation coefficient and t-test were used to assess for the convergence of the two version. RESULTS The correlation coefficients ranged from 0.52 to 0.97 for the different domain of the ASI with higher endorsement of problems in the self-administered than clinician administered version in most domains. CONCLUSION The self-administered ASI is a valid alternative to the clinician-administered ASI and it saves valuable time especially in resource-constrained settings.
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Affiliation(s)
| | - Peter Olutunde Onifade
- Drug Addiction Treatment Education and Research (DATER) Unit, Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria
| | - Ibrahim Abdu Wakawa
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, P. M. B. 1069, Maiduguri, Nigeria
- Department of Mental Health, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Sadique Kwajaffa Pindar
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, P. M. B. 1069, Maiduguri, Nigeria
- Department of Mental Health, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Mohammed Said Jidda
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, P. M. B. 1069, Maiduguri, Nigeria
- Department of Mental Health, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Umar Baba Musami
- Department of Mental Health, College of Medical Sciences, University of Maiduguri, P. M. B. 1069, Maiduguri, Nigeria
- Department of Mental Health, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Fatima Abba Ali
- Department of Mental Health, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
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Kariyanna PT, Smith LR, Patwa K, Salifu MO, McFarlane IM. Marijuana and Microcirculation: A Review. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2020; 8:284-288. [PMID: 32775630 PMCID: PMC7410519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Marijuana is the most widely used recreational drug across the United States. Ongoing efforts to legalize marijuana, as well as the drug's increasing popularity contribute to the marijuana's reputation as having a low risk profile. Marijuana's association with adverse cardiovascular events, such as arrhythmia and vasospasm is well-documented. We synthesized what is known about how marijuana use pertains to and is implicated endothelial cell damage and its effects on microcirculation. THC exerts effects through the cannabinoid receptors, CB1 and CB2. The downstream effects of CB1 activation point to a role for this receptor in atherogenesis and vasospasm, likely by precipitating oxidative stress. Endothelial cells, when exposed to reactive oxygen species, provide a stimulus for vasoconstriction with a diminished ability for vasodilation. This phenomenon has manifested itself in cases of coronary vasospastic angina, and coronary slow and no flow that have resulted from marijuana use, as confirmed by cardiac catheterization reports that showed no evidence of obstructive lesions that could otherwise be responsible for the patients' symptoms. Marijuana users suffer from acute ischemic stroke at higher rates than non-users. Several theories have been proposed to support this observation, namely marijuana induced reversible cerebral vasoconstriction syndrome, and mitochondrial damage caused by oxidative stress that disproportionately affects cerebral vasculature. As marijuana use continues to grow, so does the important of elucidating the drug's effect on endothelial cells and microcirculation. Further studies should investigate the temporal association between marijuana and endothelial damage, as well as the possibility of recovery from such injury, and whether there is therapeutic potential in cannabinoid receptors.
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81
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Schmid Y, Scholz I, Mueller L, Exadaktylos AK, Ceschi A, Liechti ME, Liakoni E. Emergency department presentations related to acute toxicity following recreational use of cannabis products in Switzerland. Drug Alcohol Depend 2020; 206:107726. [PMID: 31735534 DOI: 10.1016/j.drugalcdep.2019.107726] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/02/2019] [Accepted: 11/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Concomitant use of cannabis and other psychoactive substances is common and it is often difficult to differentiate its acute effects from those of other substances. This study aimed to characterize the acute toxicity of cannabis with and without co-use of other substances. METHODS Retrospective analysis of cases presenting at the emergency departments of three large hospitals in Switzerland due to acute toxicity related to cannabis recreational use. RESULTS Among 717 attendances related to acute cannabis toxicity, 186 (26 %) were due to use of cannabis alone. The median patient age was 26 years (range 14-68), and 73 % were male. Commonly reported symptoms/signs in lone-cannabis cases included nausea/vomiting (26 %), palpitations (25 %), anxiety (23 %), and chest pain (15 %); there were no fatalities and most intoxications were of minor severity (61 %). Most patients (83 %) using cannabis alone were discharged from the emergency department, 8 % were referred to psychiatric, and two (1 %) to the intensive care; severe complications included psychosis (7 %), coma (6 %), and seizures (5 %) and one patient (<1 %) required intubation. Lone-cannabis patients presented more often with palpitations, anxiety, panic attacks, and chest pain than patients in the co-use group, whereas the latter presented more often with impaired consciousness, agitation, respiratory depression and hallucinations, and were more often admitted to psychiatric or intensive care. CONCLUSION Intoxication with cannabis alone was mostly associated with minor toxicity. Nevertheless, severe complications and cases requiring admission to intensive or psychiatric care were also reported, which indicates that intoxication with cannabis alone does not exclude considerable health risks.
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Affiliation(s)
- Yasmin Schmid
- Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
| | - Irene Scholz
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland; Institute of Pharmacology, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Laura Mueller
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Aristomenis K Exadaktylos
- Emergency Department, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900, Lugano, Switzerland; Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Matthias E Liechti
- Division of Clinical Pharmacology and Toxicology, Basel University Hospital and University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland; Institute of Pharmacology, University of Bern, Freiburgstrasse 15, 3010, Bern, Switzerland.
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Patel RS, Manocha P, Patel J, Patel R, Tankersley WE. Cannabis Use Is an Independent Predictor for Acute Myocardial Infarction Related Hospitalization in Younger Population. J Adolesc Health 2020; 66:79-85. [PMID: 31611137 DOI: 10.1016/j.jadohealth.2019.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/28/2019] [Accepted: 07/29/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE This study aimed to evaluate the risk of various substances in young acute myocardial infarction (AMI) inpatients and analyze patient demographics and hospital outcomes for significant substance use risk factors. METHODS We conducted a retrospective analysis of the Nationwide Inpatient Sample data (2010-2014). Patients (aged 15-22 years) with a primary diagnosis for AMI (N = 1,694) were compared with non-AMI (N = 9,465,255) inpatients for odds ratio (OR) of substance use by logistic regression model, adjusted for demographics, medical risk factors, and comorbid substance use. RESULTS Tobacco (28.4%) and cannabis (14.9%) use were most prevalent in AMI inpatients. Cocaine (OR = 3.9), amphetamine (OR = 2.3), and cannabis (OR = 1.3) users were at higher risk of AMI hospitalizations. Higher proportion of cannabis users (14.7%) had major severity of illness at admission and higher mean total charge ($53,608) compared with that seen in cocaine and amphetamine users. Angioplasty was used more in cannabis users (19.4%) than others. The in-hospital mortalities were 2.7% and 2% in overall AMI cohort and cannabis users, respectively, and none in cocaine and amphetamine users. CONCLUSIONS Our study demonstrates a higher prevalence and significant odds of AMI inpatients with cannabis use, along with the potential cost burdens because of severe morbidity and higher use of treatment modalities. Physicians need to familiarize themselves with rising use of cannabis and other substances in adolescent and younger population and the typical presentations of cannabis-induced myocardial infarction.
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Affiliation(s)
| | - Pankaj Manocha
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Jenil Patel
- Department of Epidemiology, University of Arkansas for Medical Sciences (UAMS) College of Public Health, Little Rock, Arkansas
| | - Riddhi Patel
- Department of Epidemiology, University of Texas Health College of Public Health, Houston, Texas
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Archie SR, Cucullo L. Harmful Effects of Smoking Cannabis: A Cerebrovascular and Neurological Perspective. Front Pharmacol 2019; 10:1481. [PMID: 31920665 PMCID: PMC6915047 DOI: 10.3389/fphar.2019.01481] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022] Open
Abstract
Apart from being used as a medicine, cannabis or marijuana is the most widely abused recreational drug all over the world. The legalization and decriminalization of cannabis in Canada and various states of USA may be the underlying reason of the widespread popularity of it among young population. Various studies have reported about the relationship between cannabis use and different detrimental effects like cardiovascular, cerebrovascular, and neurological complications among different age groups. Specifically, the young population is getting adversely affected by this, harmful yet, readily accessible recreational drug. Although the mechanism behind cannabis mediated neurological and cerebrovascular complications has not been elucidated yet, the results of these studies have confirmed the association of these diseases with cannabis. Given the lack of comprehensive study relating these harmful complications with cannabis use, the aim of this narrative literature review article is to evaluate and summarize current studies on cannabis consumption and cerebrovascular/neurological diseases along with the leading toxicological mechanisms.
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Affiliation(s)
- Sabrina Rahman Archie
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, United States.,Center for Blood Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX, United States
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Chaphekar A, Campbell M, Middleman AB. With a High, Comes a Low: A Case of Heavy Marijuana Use and Bradycardia in an Adolescent. Clin Pediatr (Phila) 2019; 58:1550-1553. [PMID: 31179732 DOI: 10.1177/0009922819853772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Anita Chaphekar
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Matthew Campbell
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Amy B Middleman
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Cannabis-Based Medicines and Medical Cannabis in Rheumatic Diseases: A Treasure Chest or Pandora’s box. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00130-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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86
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Sanchez AM, Sennhauser S, Lozier MR, Purow JM. Will Mary Jane Leave You Heartbroken? Marijuana Use and Risk of Takotsubo Cardiomyopathy. Cureus 2019; 11:e5987. [PMID: 31807375 PMCID: PMC6876899 DOI: 10.7759/cureus.5987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC) is prevalent in 2% of patients who present with symptoms suggestive of acute myocardial infarction. It may be triggered by stressful events, resulting in catecholamine surges, myocardial stunning, and disturbances in contractility. TTC in males has been associated with marijuana use and leads to a fivefold increased risk of cardiac events. Marijuana is thought to generate a similar surge in catecholamines leading to tachycardia and elevation of both systolic and diastolic blood pressure. The question remains whether this catecholamine surge is sufficient enough to cause TTC. It is apparent a correlation between marijuana use and TTC may exist. Exogenous cannabinoid stimulation may lead to myocardial stunning via stimulation seen with hypercatecholaminergic states. Understanding the risk factors involved and increasing awareness of cardiovascular complications related to cannabinoid substances becomes more relevant as its use is increasing both recreationally and medically. We present a case of a 50 year-old African-American male with hypertension and regular marijuana use who presented with chest pain radiating to the back. Due to abnormal electrocardiogram and positive cardiac biomarkers concerning for acute coronary syndrome, the patient underwent subsequent coronary angiography that showed no significant coronary obstruction; however, left ventriculogram showed the characteristic apical ballooning of TTC. Our case highlights the pathophysiological mechanism suspected to trigger TTC.
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Affiliation(s)
- Alexandra M Sanchez
- Internal Medicine, Holy Cross Hospital/ University of Miami, Fort Lauderdale, USA
| | | | - Matthew R Lozier
- Internal Medicine, Holy Cross Hospital/ University of Miami, Fort Lauderdale, USA
| | - Joshua M Purow
- Cardiology, Jim Moran Heart and Vascular Research Institute at Holy Cross Hospital, Fort Lauderdale, USA
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[Cannabis-based medicines for chronic pain: indications, selection of drugs, effectiveness and safety : Experiences of pain physicians in Saarland]. Schmerz 2019; 33:399-406. [PMID: 31201550 DOI: 10.1007/s00482-019-0383-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There are uncertainties among physicians with respect to the indications, selection of drugs, effectiveness and safety of cannabis-based medicines for chronic pain. METHODS All statutory health insurance pain physicians in Saarland were asked to complete a self-developed questionnaire assessing their experiences with cannabis-based medicines, which they prescribed between 10 March 2017 and 30 November 2018 for adult patients with chronic cancer and non-cancer pain. RESULTS All statutory health insurance pain physicians participated in the survey and 13 out of 20 reported having prescribed cannabis-based medicines. The most frequent reasons for prescriptions in 136 patients (1.9% of the patients of the institutions) were failure of established treatment (73%) and desire of the patient (63%). In 35% of patients the type of pain was nociceptive, in 34% neuropathic, in 29% nociceptive and neuropathic and in 13% nociplastic. Dronabinol was prescribed for 95% of the patients and 71% were responders (clinically relevant reduction of pain or of other symptoms). In 29% of patients treatment was terminated due to either a lack of efficacy or adverse events. CONCLUSION Statutory health insurance pain physicians in Saarland were reluctant to prescribe cannabis-based medicines. Dronabinol was effective and well-tolerated in the majority of the highly selected patients.
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Individualize treatment when prescribing medical cannabis to older patients as efficacy data remains limited. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Manolis TA, Manolis AA, Manolis AS. Cannabis Associated "High" Cardiovascular Morbidity and Mortality: Marijuana Smoke Like Tobacco Smoke? A Déjà Vu/Déjà Vécu Story? Mini Rev Med Chem 2019; 19:870-879. [PMID: 30426899 DOI: 10.2174/1389557518666181114113947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cannabis use has increased over the past several years as some countries have legalized its use for the treatment of certain medical conditions and/or for recreational use. Thus, concerns have risen about potential adverse health effects. Increasing number of reports have associated cannabis use with serious cardiovascular (CV) complications. Furthermore, there appears to be a likeness in the harmful health effects, especially on the CV and respiratory systems, of cannabis smoking to those of tobacco smoking. OBJECTIVE To review the CV effects of cannabis use and compare them with those of tobacco use. METHODS Articles were reviewed that were published in English literature reporting on cannabis and cannabinoid pharmacology and their effects on the CV system and their consequences. Emphasis was also placed on articles reporting on cannabis use in adolescents, exposure to secondhand smoke, its effect on exercise and finally its inter-relationship and similarities with tobacco use. RESULTS With growing cannabis use, an increasing number of reports have emerged associating marijuana use with serious and life-threatening CV complications, including acute coronary syndromes, potentially lethal cardiac arrhythmias and ischemic strokes. There are certain similarities of the deleterious CV and respiratory effects of cannabis smoking with those of tobacco smoking. Despite the difference in the active ingredients (tetrahydrocannabinol vs. nicotine), each substance produces a plethora of chemicals when smoked and these are largely identical; furthermore, due to different modes of smoking, cannabis chemicals are retained in the body for a longer time. Of course, concomitant tobacco and cannabis smoking is a perplexing factor in isolating damages specifically pertaining to cannabis use, while the health risk is additive. Although the mechanisms producing CV harm may be somewhat different between these two substances, the outcome appears similar, or even worse, as the effects may emerge at a younger age. CONCLUSION There is an increasing concern that, apart from the mental health problem with cannabis smoking, societies may be facing another wave of a déjà vu/déjà vécu phenomenon similar to the tobacco smoking story.
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Affiliation(s)
| | | | - Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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Cabral DAR, da Costa KG, Tavares VDDO, Rêgo MLDM, Faro HKC, Fontes EB. Cardiorespiratory Fitness Predicts Greater Vagal Autonomic Activity in Drug Users Under Stress. Subst Abuse 2019; 13:1178221819862283. [PMID: 31384127 PMCID: PMC6664628 DOI: 10.1177/1178221819862283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/14/2019] [Indexed: 01/26/2023]
Abstract
While drug use has been shown to impair cardiac autonomic regulation, exercise might overcome some of the damage. Herein, we describe how individuals with substance use disorder (SUD) have their heart rate variability (HRV) and drug-related behaviors negatively affected in response to a stressor. However, we show how cardiorespiratory fitness may attenuate those impairments in autonomic control. Fifteen individuals with SUD were matched with 15 non-SUD individuals by age, weight, height, and fitness level, and had their HRV responses under stress induced by the Cold Pressor Test (CPT). The SUD group had lower mean of R-R intervals before and after the CPT when compared with the non-SUD group. In addition, in individuals with SUD, higher cardiorespiratory fitness level predicted greater vagal activity before, during, and after CPT. Moreover, for individuals with SUD, days of abstinence predicted greater mean of R-R intervals during recovery from the CPT. Finally, years of drug use negatively predicted mean of R-R intervals during recovery. Thus, our results suggest that chronic drug use impairs cardiac autonomic regulation at rest and after a physical stress. However, cardiorespiratory fitness might attenuate these impairments by increasing vagal autonomic activity.
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Affiliation(s)
- Daniel Aranha Rego Cabral
- NEUROex - Research Group in Physical
Activity, Cognition and Behavior, Federal University of Rio Grande do Norte, Natal,
Brazil
| | - Kell Grandjean da Costa
- NEUROex - Research Group in Physical
Activity, Cognition and Behavior, Federal University of Rio Grande do Norte, Natal,
Brazil
| | | | - Maria Luiza de Medeiros Rêgo
- NEUROex - Research Group in Physical
Activity, Cognition and Behavior, Federal University of Rio Grande do Norte, Natal,
Brazil
| | | | - Eduardo Bodnariuc Fontes
- NEUROex - Research Group in Physical
Activity, Cognition and Behavior, Federal University of Rio Grande do Norte, Natal,
Brazil
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91
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Roberts BA. Legalized Cannabis in Colorado Emergency Departments: A Cautionary Review of Negative Health and Safety Effects. West J Emerg Med 2019; 20:557-572. [PMID: 31316694 PMCID: PMC6625695 DOI: 10.5811/westjem.2019.4.39935] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/11/2022] Open
Abstract
Cannabis legalization has led to significant health consequences, particularly to patients in emergency departments and hospitals in Colorado. The most concerning include psychosis, suicide, and other substance abuse. Deleterious effects on the brain include decrements in complex decision-making, which may not be reversible with abstinence. Increases in fatal motor vehicle collisions, adverse effects on cardiovascular and pulmonary systems, inadvertent pediatric exposures, cannabis contaminants exposing users to infectious agents, heavy metals, and pesticides, and hash-oil burn injuries in preparation of drug concentrates have been documented. Cannabis dispensary workers (“budtenders”) without medical training are giving medical advice that may be harmful to patients. Cannabis research may offer novel treatment of seizures, spasticity from multiple sclerosis, nausea and vomiting from chemotherapy, chronic pain, improvements in cardiovascular outcomes, and sleep disorders. Progress has been slow due to absent standards for chemical composition of cannabis products and limitations on research imposed by federal classification of cannabis as illegal. Given these factors and the Colorado experience, other states should carefully evaluate whether and how to decriminalize or legalize non-medical cannabis use.
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Affiliation(s)
- Brad A Roberts
- University of New Mexico, Department of Emergency Medicine, Albuquerque, New Mexico Partner, Southern Colorado Emergency Medicine Associates, Pueblo, Colorado
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Puhl SL. Cannabinoid-sensitive receptors in cardiac physiology and ischaemia. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2019; 1867:118462. [PMID: 30890410 DOI: 10.1016/j.bbamcr.2019.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/04/2019] [Accepted: 03/15/2019] [Indexed: 02/06/2023]
Abstract
The classical cannabinoid receptors CB1 and CB2 as well as the cannabinoid-sensitive receptor GPR55 are widely distributed throughout the mammalian body. In the cardiovascular field, CB1 and CB2 crucially impact on diseases characterized by inflammatory processes, such as atherosclerosis and acute myocardial infarction. Both receptors and their endogenous ligands anandamide and 2-arachidonoylglycerol are up-regulated in the ischaemic heart in humans and animal models. Pharmacological and genetic interventions with CB1 and CB2 vitally affect acute ischaemia-induced cardiac inflammation. Herein, CB1 rather aggravates the inflammatory response whereas CB2 mitigates inflammation via directly affecting immune cell attraction, macrophage polarization and lymphocyte clusters in the pericardial adipose tissue. Furthermore, cannabinoids and their receptors affect numerous cardiac risk factors. In this context, cannabis consumption is debated to trigger arrhythmias and even myocardial infarction. Moreover, CB1 activation is linked to impaired lipid and glucose metabolism and therefore obesity and diabetes, while its antagonism leads to the reduction of plasma triglycerides, low-density lipoprotein cholesterol, leptin, insulin and glucose. On the other hand, activation of cannabinoid-sensitive receptors can also counteract unfavourable predictors for cardiovascular diseases. In particular, hypertension can be mitigated via CB1 agonism and impaired adrenoceptor responsiveness prevented by functional GPR55. Taken together, current insights identify the cannabinoid system as promising target not only to therapeutically interfere with the vasculature, but also to affect the heart as target organ. This review discusses current knowledge regarding a direct cardiac role of the cannabinoid system and points out its feasible therapeutic manipulation in the ischaemic myocardium.
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Affiliation(s)
- Sarah-Lena Puhl
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University (LMU), Pettenkoferstrasse 9, 80336 Munich, Germany.
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Akinnusi M, El Solh AA. Drug treatment strategies for insomnia in patients with post-traumatic stress disorder. Expert Opin Pharmacother 2019; 20:691-699. [PMID: 30794468 DOI: 10.1080/14656566.2019.1574745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Insomnia is among the most reported sleep disturbances in patients with post-traumatic stress disorder (PTSD). The pervasiveness of this disorder among trauma-inflicted civilians and military personnel has been associated with reduced quality of life, impaired psychosocial functioning including cognitive impairments, negative mood swings, cardiovascular complications, and increased utilization of medical services. AREAS COVERED This review describes the current state of science with respect to the impact of the most dispensed pharmacological interventions for posttraumatic insomnia. At the present, there are no established treatment algorithms for PTSD-related insomnia. Pharmacotherapy offers an alternative treatment modality for patients with PTSD who fail or decline cognitive behavioral therapy (CBT). Selection of a hypnotic/sedative agent should be based on the patient's history, precipitating and perpetuating factors of insomnia, side effect profile, and potential medication-related interactions. Antipsychotics and benzodiazepines appear ineffective or are associated with significant harm in treating PTSD-related insomnia. EXPERT OPINION In the absence of randomized controlled trials, prescription patterns have been guided by anecdotal reports and expert opinion. Due to the complexity and multifactorial etiology of insomnia in PTSD, clinical investigations should examine available pharmacologic agents in comparative trials or in combination with CBT or complementary therapies to assess both short-term and long-term sleep outcomes in this population.
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Affiliation(s)
- Morohunfolu Akinnusi
- a Department of Medicine , StrongTower Behavioral HealthCare , Marietta , GA , USA
| | - Ali A El Solh
- b Department of Medicine , VA Western New York Healthcare System , Buffalo , NY , USA.,c Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine , State University of New York at Buffalo , USA.,d Department of Epidemiology and Environmental Health , State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions , USA
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Benowitz NL. Managing Cannabis Use in Patients With Cardiovascular Disease. Can J Cardiol 2019; 35:138-141. [DOI: 10.1016/j.cjca.2018.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022] Open
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Prospects for the Use of Cannabinoids in Oncology and Palliative Care Practice: A Review of the Evidence. Cancers (Basel) 2019; 11:cancers11020129. [PMID: 30678303 PMCID: PMC6406915 DOI: 10.3390/cancers11020129] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/20/2019] [Accepted: 01/20/2019] [Indexed: 01/15/2023] Open
Abstract
There is an increased interest in the use of cannabinoids in the treatment of symptoms in cancer and palliative care patients. Their multimodal action, in spite of limited efficacy, may make them an attractive alternative, particularly in patients with multiple concomitant symptoms of mild and moderate intensity. There is evidence to indicate cannabis in the treatment of pain, spasticity, seizures, sleep disorders, nausea and vomiting, and Tourette syndrome. Although the effectiveness of cannabinoids is limited, it was confirmed in neuropathic pain management and combination with opioids. A relatively favorable adverse effects profile, including no depressive effect on the respiratory system, may make cannabis complement a rather narrow armamentarium that is in the disposition of a palliative care professional.
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Fitzcharles MA, Niaki OZ, Hauser W, Hazlewood G. Position Statement: A Pragmatic Approach for Medical Cannabis and Patients with Rheumatic Diseases. J Rheumatol 2019; 46:532-538. [DOI: 10.3899/jrheum.181120] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 01/13/2023]
Abstract
Objective.Pain is one reason some rheumatology patients may consider use of medical cannabis, a product increasingly perceived as a safe and neglected natural treatment option for many conditions. Legalization of recreational cannabis in Canada will promote access to cannabis. Physicians must therefore provide patients with the best evidence-based information regarding the medicinal effects and harm of cannabis.Methods.The Canadian Rheumatology Association (CRA) mandated the development of a position statement for medical cannabis and the rheumatology patient. The current literature regarding the effects of medical cannabis for rheumatology patients was assessed, and a pragmatic position statement to facilitate patient care was developed by the Therapeutics Committee of the CRA and approved by the CRA board.Results.There are no clinical trials of medical cannabis in rheumatology patients. Evidence is insufficient about the benefit of pharmaceutical cannabinoids in fibromyalgia, osteoarthritis, rheumatoid arthritis, and back pain, but there is evidence of a high risk of harm. Extrapolating from other conditions, medical cannabis may provide some symptom relief for some patients. Short-term risks of psychomotor effects can be anticipated, but longterm risks have not been determined and are of concern.Conclusion.Despite lack of evidence for use of medical cannabis in rheumatology patients, we acknowledge the need to provide empathetic and pragmatic guidance for patient care. This position statement aims to facilitate the dialogue between patients and healthcare professionals in a mutually respectful manner to ensure harm reduction for patients and society.
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Abstract
Cannabinoids influence cardiovascular variables in health and disease via multiple mechanisms. The chapter covers the impact of cannabinoids on cardiovascular function in physiology and pathology and presents a critical analysis of the proposed signalling pathways governing regulation of cardiovascular function by endogenously produced and exogenous cannabinoids. We know that endocannabinoid system is overactivated under pathological conditions and plays both a protective compensatory role, such as in some forms of hypertension, atherosclerosis and other inflammatory conditions, and a pathophysiological role, such as in disease states associated with excessive hypotension. This chapter focuses on the mechanisms affecting hemodynamics and vasomotor effects of cannabinoids in health and disease states, highlighting mismatches between some studies. The chapter will first review the effects of marijuana smoking on cardiovascular system and then describe the impact of exogenous cannabinoids on cardiovascular parameters in humans and experimental animals. This will be followed by analysis of the impact of cannabinoids on reactivity of isolated vessels. The article critically reviews current knowledge on cannabinoid induction of vascular relaxation by cannabinoid receptor-dependent and -independent mechanisms and dysregulation of vascular endocannabinoid signaling in disease states.
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Affiliation(s)
- Alexander I Bondarenko
- Circulatory Physiology Department, Bogomoletz Institute of Physiology National Academy of Sciences of Ukraine, Kiev, Ukraine.
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Recurrent STEMI Precipitated by Marijuana Use: Case Report and Literature Review. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2018; 6:163-168. [PMID: 30294673 DOI: 10.12691/ajmcr-6-8-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Marijuana abuse is rapidly growing and currently it is the most coimnon drug of abuse in the United States due to increased legalization for recreational and medicinal use. Delta 9-tetrahydrocannibol, the main psychoactive compound in marijuana, acts via the endocannabinoid system to elicit various cardiovascular physiological effects, and has been associated with many adverse cardiovascular effects such as acute coronary syndrome, arrhythmias, and sudden cardiac death that have previously been reported by our group and others. We present a case of a 30-year-old African-American male with no cardiovascular disease (CVD) risk factors with recurrent ST-segment elevation myocardial infarctions (STEMI) whose coronary angiography revealed recurrent 100% occlusion of the left anterior descending artery (LAD) in the setting of marijuana smoking. It was the patient's third STEMI with 100% occlusion of the LAD with each STEMI secondary to thrombosis of a different region of the LAD. Marijuana use was confirmed by urine toxicology screening at each STEMI presentation. Coronary angiography on multiple occasions was negative for stenosis of other epicardial coronary arteries, and coronary calcimn scoring was zero. Evaluation for other cardiovascular risk factors including family history of premature coronary artery disease, dyslipidemia, diabetes, and hypercoagulable disorders was negative. Further studies are required to elucidate the mechanisms of marijuana-associated coronary thrombosis and myocardial infarction.
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