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Echeverria-Villalobos M, Guevara Y, Mitchell J, Ryskamp D, Conner J, Bush M, Periel L, Uribe A, Weaver TE. Potential perioperative cardiovascular outcomes in cannabis/cannabinoid users. A call for caution. Front Cardiovasc Med 2024; 11:1343549. [PMID: 38978789 PMCID: PMC11228818 DOI: 10.3389/fcvm.2024.1343549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/15/2024] [Indexed: 07/10/2024] Open
Abstract
Background Cannabis is one of the most widely used psychoactive substances. Its components act through several pathways, producing a myriad of side effects, of which cardiovascular events are the most life-threatening. However, only a limited number of studies address cannabis's perioperative impact on patients during noncardiac surgery. Methods Studies were identified by searching the PubMed, Medline, EMBASE, and Google Scholar databases using relevant keyword combinations pertinent to the topic. Results Current evidence shows that cannabis use may cause several cardiovascular events, including abnormalities in cardiac rhythm, myocardial infarction, heart failure, and cerebrovascular events. Additionally, cannabis interacts with anticoagulants and antiplatelet agents, decreasing their efficacy. Finally, the interplay of cannabis with inhalational and intravenous anesthetic agents may lead to adverse perioperative cardiovascular outcomes. Conclusions The use of cannabis can trigger cardiovascular events that may depend on factors such as the duration of consumption, the route of administration of the drug, and the dose consumed, which places these patients at risk of drug-drug interactions with anesthetic agents. However, large prospective randomized clinical trials are needed to further elucidate gaps in the body of knowledge regarding which patient population has a greater risk of perioperative complications after cannabis consumption.
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Affiliation(s)
| | - Yosira Guevara
- Department of Anesthesiology, St Elizabeth’s Medical Center, Brighton, MA, United States
| | - Justin Mitchell
- Department of Anesthesiology & Perioperative Medicine, UCLA Medical Center, Los Angeles, CA, United States
| | - David Ryskamp
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Joshua Conner
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Margo Bush
- University of Toledo, College of Medicine and Life Sciences, Toledo, OH, United States
| | - Luis Periel
- Touro College of Osteopathic Medicine, New York, NW, United States
| | - Alberto Uribe
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tristan E. Weaver
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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2
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Dietz N, Alkin V, Agarwal N, Sharma M, Oxford BG, Wang D, Ugiliweneza B, Mettille J, Boakye M, Drazin D. Cannabis Use Disorder Trends and Health Care Utilization After Cervical and Lumbar Spine Fusions. Spine (Phila Pa 1976) 2024; 49:E28-E45. [PMID: 37962203 DOI: 10.1097/brs.0000000000004874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To identify differences in complication rates after cervical and lumbar fusion over the first postoperative year between those with and without cannabis use disorder (CUD) and to assess how CUD affects opioid prescription patterns. SUMMARY OF BACKGROUND DATA Cannabis is legal for medical purposes in 36 states and for recreational use in 18 states. Cannabis has multisystem effects and may contribute to transient vasoconstrictive, prothrombotic, and inflammatory effects. METHODS The IBM MarketScan Database (2009-2019) was used to identify patients who underwent cervical or lumbar fusions, with or without CUD. Exact match hospitalization and postdischarge outcomes were analyzed at index, six, and 12 months. RESULTS Of 72,024 cervical fusion (2.0% with CUD) and 105,612 lumbar fusion patients (1.5% with CUD), individuals with CUD were more likely to be young males with higher Elixhauser index. The cervical CUD group had increased neurological complications (3% vs. 2%) and sepsis (1% vs. 0%) during the index hospitalization and neurological (7% vs. 5%) and wound complications (5% vs. 3%) at 12 months. The lumbar CUD group had increased wound (8% vs. 5%) and myocardial infarction (MI) (2% vs. 1%) complications at six months and at 12 months. For those with cervical myelopathy, increased risk of pulmonary complications was observed with CUD at index hospitalization and 12-month follow-up. For those with lumbar stenosis, cardiac complications and MI were associated with CUD at index hospitalization and 12 months. CUD was associated with opiate use disorder, decreasing postoperatively. CONCLUSIONS No differences in reoperation rates were observed for CUD groups undergoing cervical or lumbar fusion. CUD was associated with an increased risk of stroke for the cervical fusion cohort and cardiac (including MI) and pulmonary complications for lumbar fusion at index hospitalization and six and 12 months postoperatively. Opiate use disorder and decreased opiate dependence after surgery also correlated with CUD.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | | | - Nitin Agarwal
- Washington University, Barnes Jewish Hospital Plaza, St. Louis, MO
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | | | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, KY
- Department of Health Management and Systems Science, School of Public Health and Information Science, University of Louisville, Louisville, KY
| | | | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, KY
| | - Doniel Drazin
- Providence Regional Medical Center Everett, Everett, WA
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3
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Muacevic A, Adler JR, Chowdhury T, Shankar M, Panigrahi K. A Case Report of Cannabis Abuse: A Surprising Etiology of Elevated Troponin. Cureus 2023; 15:e33423. [PMID: 36751195 PMCID: PMC9899153 DOI: 10.7759/cureus.33423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
Cannabis is the most commonly used additive drug after alcohol and tobacco. There has been literature proving the relationship between cannabis use and elevated troponin from myocardial infarction, with many mechanisms explaining them. However, limited data are available on elevated troponin due to cannabis-induced high myocardial oxygen demand due to vasospasm. We present a case of a 21-year-old female presenting with chest pain after cannabis abuse. She exhibited a steep rise in troponin with a normal electrocardiogram (EKG). She refused a coronary angiogram, but a bedside echocardiogram showed no wall motion abnormality. Therefore, the dramatic rise of troponin levels with the chest pain and the resolution of the symptoms were most likely explained by demand ischemia via the mechanism of reversible vasospasm.
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4
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Mensah E, Tabrizchi R, Daneshtalab N. Pharmacognosy and Effects of Cannabinoids in the Vascular System. ACS Pharmacol Transl Sci 2022; 5:1034-1049. [PMID: 36407955 PMCID: PMC9667477 DOI: 10.1021/acsptsci.2c00141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Indexed: 11/29/2022]
Abstract
Understanding the pharmacodynamics of cannabinoids is an essential subject due to the recent increasing global acceptance of cannabis and its derivation for recreational and therapeutic purposes. Elucidating the interaction between cannabinoids and the vascular system is critical to exploring cannabinoids as a prospective therapeutic agent for treating vascular-associated clinical conditions. This review aims to examine the effect of cannabinoids on the vascular system and further discuss the fundamental pharmacological properties and mechanisms of action of cannabinoids in the vascular system. Data from literature revealed a substantial interaction between endocannabinoids, phytocannabinoids, and synthetic cannabinoids within the vasculature of both humans and animal models. However, the mechanisms and the ensuing functional response is blood vessels and species-dependent. The current understanding of classical cannabinoid receptor subtypes and the recently discovered atypical cannabinoid receptors and the development of new synthetic analogs have further enhanced the pharmacological characterization of the vascular cannabinoid receptors. Compelling evidence also suggest that cannabinoids represent a formidable therapeutic candidate for vascular-associated conditions. Nonetheless, explanations of the mechanisms underlining these processes are complex and paradoxical based on the heterogeneity of receptors and signaling pathways. Further insight from studies that uncover the mechanisms underlining the therapeutic effect of cannabinoids in the treatment of vascular-associated conditions is required to determine whether the known benefits of cannabinoids thus currently outweigh the known/unknown risks.
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Affiliation(s)
- Eric Mensah
- Faculty
of Medicine, Division of Biomedical Sciences, Memorial University of Newfoundland and Labrador, St. John’s, NL A1C 5S7, Canada
| | - Reza Tabrizchi
- Faculty
of Medicine, Division of Biomedical Sciences, Memorial University of Newfoundland and Labrador, St. John’s, NL A1C 5S7, Canada
| | - Noriko Daneshtalab
- School
of Pharmacy, Memorial University of Newfoundland
and Labrador, St. John’s, NL A1B 3V6, Canada
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5
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Ibarra‐Lecue I, Unzueta‐Larrinaga P, Barrena‐Barbadillo R, Villate A, Horrillo I, Mendivil B, Landabaso MA, Meana JJ, Etxebarria N, Callado LF, Urigüen L. Cannabis use selectively modulates circulating biomarkers in the blood of schizophrenia patients. Addict Biol 2022; 27:e13233. [PMID: 36301212 PMCID: PMC9539611 DOI: 10.1111/adb.13233] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/05/2022] [Accepted: 08/30/2022] [Indexed: 01/24/2023]
Abstract
Cannabis use disorder is frequent in schizophrenia patients, and it is associated with an earlier age of onset and poor schizophrenia prognosis. Serotonin 2A receptors (5-HT2AR) have been involved in psychosis and, like Akt kinase, are known to be modulated by THC. Likewise, endocannabinoid system dysregulation has been suggested in schizophrenia. The presence of these molecules in blood makes them interesting targets, as they can be evaluated in patients by a minimally invasive technique. The aim of the present study was to evaluate 5-HT2AR protein expression and the Akt functional status in platelet homogenates of subjects diagnosed with schizophrenia, cannabis use disorder, or both conditions, compared with age- and sex-matched control subjects. Additionally, endocannabinoids and pro-inflammatory interleukin-6 (IL-6) levels were also measured in the plasma of these subjects. Results showed that both platelet 5-HT2AR and the active phospho (Ser473)Akt protein expression were significantly increased in schizophrenia subjects, whereas patients with a dual diagnosis of schizophrenia and cannabis use disorder did not show significant changes. Similarly, plasma concentrations of anandamide and other lipid mediators such as PEA and DEA, as well as the pro-inflammatory IL-6, were significantly increased in schizophrenia, but not in dual subjects. Results demonstrate that schizophrenia subjects show different circulating markers pattern depending on the associated diagnosis of cannabis use disorder, supporting the hypothesis that there could be different underlying mechanisms that may explain clinical differences among these groups. Moreover, they provide the first preliminary evidence of peripherally measurable molecules of interest for bigger prospective studies in these subpopulations.
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Affiliation(s)
- Inés Ibarra‐Lecue
- Department of PharmacologyUniversity of the Basque Country UPV/EHULeioaBizkaiaSpain,Present address:
Department of Psychiatry, College of Physicians and Surgeons, Columbia UniversityNew York and New York State Psychiatric InstituteNew YorkNew YorkUSA,New York State Psychiatric InstituteNew YorkNew YorkUSA
| | - Paula Unzueta‐Larrinaga
- Department of PharmacologyUniversity of the Basque Country UPV/EHULeioaBizkaiaSpain,Biocruces Bizkaia Health Research InstituteBarakaldoBizkaiaSpain
| | | | - Aitor Villate
- Department of Analytical ChemistryUniversity of the Basque Country UPV/EHULeioaBizkaiaSpain,PiE‐UPV/EHU, Plentzia Itsas EstazioaAreatza PasealekuaPlentziaBizkaia48620Spain
| | - Igor Horrillo
- Department of PharmacologyUniversity of the Basque Country UPV/EHULeioaBizkaiaSpain,Biocruces Bizkaia Health Research InstituteBarakaldoBizkaiaSpain,Centro de Investigación Biomédica en Red de Salud MentalInstituto de Salud Carlos IIIMadridSpain
| | | | | | - J. Javier Meana
- Department of PharmacologyUniversity of the Basque Country UPV/EHULeioaBizkaiaSpain,Biocruces Bizkaia Health Research InstituteBarakaldoBizkaiaSpain,Centro de Investigación Biomédica en Red de Salud MentalInstituto de Salud Carlos IIIMadridSpain
| | - Nestor Etxebarria
- Department of Analytical ChemistryUniversity of the Basque Country UPV/EHULeioaBizkaiaSpain,PiE‐UPV/EHU, Plentzia Itsas EstazioaAreatza PasealekuaPlentziaBizkaia48620Spain
| | - Luis F. Callado
- Department of PharmacologyUniversity of the Basque Country UPV/EHULeioaBizkaiaSpain,Biocruces Bizkaia Health Research InstituteBarakaldoBizkaiaSpain,Centro de Investigación Biomédica en Red de Salud MentalInstituto de Salud Carlos IIIMadridSpain
| | - Leyre Urigüen
- Department of PharmacologyUniversity of the Basque Country UPV/EHULeioaBizkaiaSpain,Biocruces Bizkaia Health Research InstituteBarakaldoBizkaiaSpain,Centro de Investigación Biomédica en Red de Salud MentalInstituto de Salud Carlos IIIMadridSpain
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6
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Rosa GM, Puce L, Mori L, Currà A, Fattapposta F, Porto I, Bragazzi NL, Trompetto C, Marinelli L. Nabiximols effect on blood pressure and heart rate in post-stroke patients of a randomized controlled study. Front Cardiovasc Med 2022; 9:990188. [PMID: 36386386 PMCID: PMC9650544 DOI: 10.3389/fcvm.2022.990188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/11/2022] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Cannabinoids may be useful to treat pain, epilepsy and spasticity, although they may bear an increased risk of cardiovascular events. This study aims to evaluate the cardiovascular safety of nabiximols, a cannabis-based drug, in patients with spasticity following stroke, thus presenting an increased cardiovascular risk. METHODS This is an ancillary study stemming from the SativexStroke trial: a randomized double-blind, placebo-controlled, crossover study aimed at assessing the effect of nabiximols on post-stroke spasticity. Patients were treated with nabiximols oromucosal spray or placebo and assessed before and after two phases of 1-month duration each. Only the phase with the active treatment was considered for each patient who completed the study. The average values of blood pressure (diastolic, systolic, differential) and heart rate from the first 5 days of the phase (lowest nabiximols dosage) were compared to the average values recorded during the last 5 days at the end of the phase (highest nabiximols dosage). Baseline comparisons between gender, stroke type and affected side and correlation between age and blood pressure and heart rate were performed. The study was registered with the EudraCT number 2016-001034-10. RESULTS Thirty-four patients completed the study and were included in the analysis. Thirty-one were taking antihypertensive drugs and, among these, 12 were taking beta-blockers. During the study, no arrhythmic events were recorded, blood pressure and heart rate did not show pathological fluctuations, and no cardiovascular or cerebrovascular events occurred. At baseline blood pressure and heart rate were comparable concerning gender, stroke type and affected side. A significant direct correlation emerged between differential blood pressure and age and an inverse correlation between diastolic blood pressure and age. No correlation emerged between systolic blood pressure or heart rate and age. Blood pressure and heart rate did not change during nabiximols treatment compared to the baseline condition. CONCLUSION This ancillary study adds evidence that, in patients who already underwent a cerebrovascular accident, nabiximols does not determine significant blood pressure and heart rate variation or cardiovascular complications. These data support the cardiovascular safety of nabiximols, encouraging more extensive studies involving cannabinoids characterized by slow absorption rates.
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Affiliation(s)
- Gian Marco Rosa
- Cardiology Clinic, Department of Internal Medicine and Medical Specialties, University of Genoa, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Laura Mori
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Antonio Currà
- Department of Medical-Surgical Sciences and Biotechnologies, A. Fiorini Hospital, Sapienza University of Rome, Latina, Italy
| | | | - Italo Porto
- Cardiology Clinic, Department of Internal Medicine and Medical Specialties, University of Genoa, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Carlo Trompetto
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Lucio Marinelli
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
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7
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Dabiri AE, Kassab GS. Effects of Cannabis on Cardiovascular System: The Good, the Bad, and the Many Unknowns. Med Cannabis Cannabinoids 2021; 4:75-85. [PMID: 35224427 PMCID: PMC8832198 DOI: 10.1159/000519775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/20/2021] [Indexed: 09/29/2023] Open
Abstract
Cannabis is currently the most consumed illicit substance in the world, and gradual legalization in the USA makes it important to understand the health consequences of the use of this substance. With growing body of evidence that some cannabis ingredients may be beneficial in various aspects of hemostasis, additional research is clearly needed in various clinical areas. In addition to understanding the efficacy, research efforts should also include studies that address any harmful effects of the compounds or administration methods that may result in adverse effects. This review is focused on the cardiometabolic effects of cannabis use. Cardiometabolic diseases are among the leading causes of death in the USA and around the world. The purpose of this review was to provide an overview of the known medicinal benefits of selected cannabis cannabinoids and the known side effects or contraindications. More importantly, we have proposed new questions and signposts in cannabis research to uncover additional medicinal benefits and identify the health hazards with focus on cardiovascular disease.
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Affiliation(s)
- Ali E. Dabiri
- California Medical Innovation Institute, San Diego, California, USA
- 3DTholdings, San Diego, California, USA
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8
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Harada HA, Liu J, Shortell JD, Beesley SJ. A 20-Year-Old Man with e-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) and Thrombotic Coagulopathy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929915. [PMID: 33854029 PMCID: PMC8056776 DOI: 10.12659/ajcr.929915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND In 2019, the US Centers for Disease Control and Prevention (CDC) described the criteria for the diagnosis of e-cigarette or vaping product use-associated lung injury (EVALI), which may be caused by contamination of delta-9-tetrahydrocannabinoid (THC) e-liquids with vitamin E acetate. This report describes a case of a 20-year-old man with a history of recreational drug use that included vaping, who presented with EVALI and a coagulopathy associated with thrombotic events. CASE REPORT We present a 20-year-old patient who worked at a cannabidiol (CBD) manufacturing facility with a history of e-cigarette use and polysubstance abuse in remission who presented with respiratory and gastrointestinal symptoms accompanied by 50-pound weight loss over 6 months. The patient had been vaping with nicotine and THC-containing e-cigarettes multiple times per day for 1.5 years. He met the CDC surveillance criteria for EVALI, consisting of respiratory symptoms and infiltrates on imaging within 90 days of vaping, and was found to have eosinophilic pneumonia secondary to THC-containing e-cigarette use. Additionally, thrombi were detected in the pulmonary arteries, right saphenous vein, and right ventricle. A segmental infarct was noted in the inferior pole of the left kidney. CONCLUSIONS We present the second case report potentially linking e-cigarette use with clinically significant thrombogenesis, the first with both arterial and venous thromboses. This report demonstrates the importance of taking a history of e-cigarette use in patients presenting with lung injury. Although EVALI and the diagnostic criteria have only recently been described, systemic effects, including coagulopathy, are now being reported.
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Affiliation(s)
- Holly A Harada
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Jeremy Liu
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Justin D Shortell
- Department of Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Sarah J Beesley
- Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT, USA.,Pulmonary Division, University of Utah School of Medicine, Salt Lake City, UT, USA
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9
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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: 6] [Impact Index Per Article: 2.0] [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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10
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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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11
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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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12
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Patel RS, Kamil SH, Bachu R, Adikey A, Ravat V, Kaur M, Tankersley WE, Goyal H. Marijuana use and acute myocardial infarction: A systematic review of published cases in the literature. Trends Cardiovasc Med 2019; 30:298-307. [PMID: 31439383 DOI: 10.1016/j.tcm.2019.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Marijuana use has gained popularity following legalization in the US. Marijuana can affect the heart through various mechanisms. This study aims to conduct a systematic review of published case reports of individuals with acute myocardial infarction (AMI) following marijuana use. METHODS We conducted a systematic review of literature, including case reports, case series, and the letter to the editor on MEDLINE. Forty-six studies were included, with a total number of 62 patients with AMI and marijuana use. RESULTS The mean age was 27.7 (±10.3) years with male predominance. About 3.7 g marijuana was used for an average of 9.7 years by the patients. From the cases reporting the onset of AMI symptoms, the average time was within 5 h after last marijuana use. The angiographic findings were normal in 36.8% of cases. In 42.1% of individuals, the left anterior descending coronary artery was occluded, making it the most common artery involved, followed by the right coronary artery (10.5%). Most cases were managed medically, followed by thrombectomy and stent placement, and percutaneous transluminal coronary angioplasty (PTCA). Complications included cardio-embolic stroke, and seven deaths were reported. CONCLUSION It is important to consider episodic marijuana use as a significant risk factor of AMI, particularly in individuals with no cardiac risk factors, as delay in management can result in fatal outcomes including increased risk of mortality.
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Affiliation(s)
- Rikinkumar S Patel
- Department of Psychiatry, Griffin Memorial Hospital and Oklahoma Department of Mental Health and Substance abuse (ODMHAS), Norman, OK 73071, USA
| | - Saher H Kamil
- Department of Psychiatry, Austin State Hospital, Austin, TX 78751, USA
| | - Ramya Bachu
- Department of Medicine, Baptist Health Medical Center, North Little Rock, AR 72117, USA
| | - Archana Adikey
- Department of Psychiatry, Virginia Tech Carilion Clinic, Roanoke, VA 24018, USA
| | - Virendrasinh Ravat
- Department of Medicine, Larkin Community Hospital, South Miami, FL 33143, USA
| | - Mandeep Kaur
- American University of Antigua, Jabberwock Beach Road PO Box W1451 Coolidge, Antigua
| | - William E Tankersley
- Department of Psychiatry, Griffin Memorial Hospital and Oklahoma Department of Mental Health and Substance abuse (ODMHAS), Norman, OK 73071, USA
| | - Hemant Goyal
- Department of Medicine, The Wright Center of Graduate Medical Education, Scranton, PA 18503, USA.
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13
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ST elevation myocardial infarction following a cannabis smoking binge. Cardiol Young 2019; 29:847-848. [PMID: 31199218 DOI: 10.1017/s1047951119001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cannabis smoking is considered the most popular illicit drug used worldwide. We present the case of a 26-year-old male with ST elevation myocardial infarction and heart failure subsequent to cannabis smoking abuse. We searched the literature regarding acute myocardial infarction following cannabis smoking and the possible pathophysiologic mechanisms.
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14
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Banister SD, Arnold JC, Connor M, Glass M, McGregor IS. Dark Classics in Chemical Neuroscience: Δ 9-Tetrahydrocannabinol. ACS Chem Neurosci 2019; 10:2160-2175. [PMID: 30689342 DOI: 10.1021/acschemneuro.8b00651] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cannabis ( Cannabis sativa) is the most widely used illicit drug in the world, with an estimated 192 million users globally. The main psychoactive component of cannabis is (-)- trans-Δ9-tetrahydrocannabinol (Δ9-THC), a compound with a diverse range of pharmacological actions. The unique and distinctive intoxication caused by Δ9-THC primarily reflects partial agonist action at central cannabinoid type 1 (CB1) receptors. Δ9-THC is an approved therapeutic treatment for a range of conditions, including chronic pain, chemotherapy-induced nausea and vomiting, and multiple sclerosis, and is being investigated in indications such as anorexia nervosa, agitation in dementia, and Tourette's syndrome. It is available as a regulated pharmaceutical in products such as Marinol, Sativex, and Namisol as well as in an ever-increasing range of unregistered medicinal and recreational cannabis products. While cannabis is an ancient medicament, contemporary use is embroiled in legal, scientific, and social controversy, much of which relates to the potential hazards and benefits of Δ9-THC itself. Robust contemporary debate surrounds the therapeutic value of Δ9-THC in different diseases, its capacity to produce psychosis and cognitive impairment, and the addictive and "gateway" potential of the drug. This review will provide a profile of the chemistry, pharmacology, and therapeutic uses of Δ9-THC as well as the historical and societal import of this unique, distinctive, and ubiquitous psychoactive substance.
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Affiliation(s)
- Samuel D. Banister
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- Faculty of Science and School of Chemistry, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jonathon C. Arnold
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- School of Medical Science and Discipline of Pharmacology, The University of Sydney, Sydney, NSW 2006, Australia
| | - Mark Connor
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Michelle Glass
- Department of Pharmacology and Toxicology, University of Otago, Dunedin 9016, New Zealand
| | - Iain S. McGregor
- Lambert Initiative for Cannabinoid Therapeutics, Brain and Mind Centre, The University of Sydney, Sydney, NSW 2050, Australia
- Faculty of Science and School of Psychology, The University of Sydney, Sydney, NSW 2006, Australia
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15
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Richards JR, Bing ML, Moulin AK, Elder JW, Rominski RT, Summers PJ, Laurin EG. Cannabis use and acute coronary syndrome. Clin Toxicol (Phila) 2019; 57:831-841. [DOI: 10.1080/15563650.2019.1601735] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- John R. Richards
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Mary L. Bing
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Aimee K. Moulin
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Joshua W. Elder
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Robert T. Rominski
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Phillip J. Summers
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Erik G. Laurin
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA
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16
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Pacher P, Steffens S, Haskó G, Schindler TH, Kunos G. Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol 2017; 15:151-166. [DOI: 10.1038/nrcardio.2017.130] [Citation(s) in RCA: 248] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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17
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Jouanjus E, Raymond V, Lapeyre-Mestre M, Wolff V. What is the Current Knowledge About the Cardiovascular Risk for Users of Cannabis-Based Products? A Systematic Review. Curr Atheroscler Rep 2017; 19:26. [DOI: 10.1007/s11883-017-0663-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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Reece AS, Norman A, Hulse GK. Cannabis exposure as an interactive cardiovascular risk factor and accelerant of organismal ageing: a longitudinal study. BMJ Open 2016; 6:e011891. [PMID: 27821595 PMCID: PMC5129004 DOI: 10.1136/bmjopen-2016-011891] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Many reports exist of the cardiovascular toxicity of smoked cannabis but none of arterial stiffness measures or vascular age (VA). In view of its diverse toxicology, the possibility that cannabis-exposed patients may be ageing more quickly requires investigation. DESIGN Cross-sectional and longitudinal, observational. Prospective. SETTING Single primary care addiction clinic in Brisbane, Australia. PARTICIPANTS 11 cannabis-only smokers, 504 tobacco-only smokers, 114 tobacco and cannabis smokers and 534 non-smokers. EXCLUSIONS known cardiovascular disease or therapy or acute exposure to alcohol, amphetamine, heroin or methadone. INTERVENTION Radial arterial pulse wave tonometry (AtCor, SphygmoCor, Sydney) performed opportunistically and sequentially on patients between 2006 and 2011. MAIN OUTCOME MEASURE Algorithmically calculated VA. SECONDARY OUTCOMES other central haemodynamic variables. RESULTS Differences between group chronological ages (CA, 30.47±0.48 to 40.36±2.44, mean±SEM) were controlled with linear regression. Between-group sex differences were controlled by single-sex analysis. Mean cannabis exposure among patients was 37.67±7.16 g-years. In regression models controlling for CA, Body Mass Index (BMI), time and inhalant group, the effect of cannabis use on VA was significant in males (p=0.0156) and females (p=0.0084). The effect size in males was 11.84%. A dose-response relationship was demonstrated with lifetime exposure (p<0.002) additional to that of tobacco and opioids. In both sexes, the effect of cannabis was robust to adjustment and was unrelated to its acute effects. Significant power interactions between cannabis exposure and the square and cube of CA were demonstrated (from p<0.002). CONCLUSIONS Cannabis is an interactive cardiovascular risk factor (additional to tobacco and opioids), shows a prominent dose-response effect and is robust to adjustment. Cannabis use is associated with an acceleration of the cardiovascular age, which is a powerful surrogate for the organismal-biological age. This likely underlies and bi-directionally interacts with its diverse toxicological profile and is of considerable public health and regulatory importance.
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Affiliation(s)
- Albert Stuart Reece
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Amanda Norman
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Gary Kenneth Hulse
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, Western Australia, Australia
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