1
|
Ding C, Xu D, Cheng T. Cannabis Use Disorder Associated With Increased Risk of Postoperative Complications After Hip or Knee Arthroplasties: A Meta-analysis of Observational Studies. J Am Acad Orthop Surg 2024:00124635-990000000-00988. [PMID: 38759231 DOI: 10.5435/jaaos-d-23-00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/02/2023] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION With the legalization of marijuana in the United States, the number of patients with cannabis use disorder (CUD) in the joint arthroplasty population has increased markedly. The primary purpose of this meta-analysis was to determine whether there were differences in clinical and economic outcomes after total joint arthroplasty (TJA) between patients with and without perioperative CUD. METHODS We searched PubMed, Embase, Scopus, and Web of Science databases up to July 2018 to identify all eligible studies investigating the association of CUD with postoperative outcomes in patients undergoing TJA. Postoperative outcomes assessed consisted of complications, readmission, length of stay (LOS), implant revision, and cost of care. For dichotomous outcomes, pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. RESULTS We identified 10 retrospective cohort studies with a total of 17,981,628 study participants. Patients with CUD had significantly higher odds of medical complications (OR 1.33 [95% CI 1.07 to 1.66], P = 0.01) and implant-related complications (OR 1.75 [95% CI: 1.64 to 1.88], P < 0.00001) than noncannabis users. Specifically, CUD was associated with significantly increased odds of cardiac complications (OR 1.95 [95% CI 1.50 to 2.54], P < 0.00001), cerebrovascular accidents (OR 2.06 [95% CI 1.66 to 2.57], P < 0.00001), postoperative infections (OR 1.68 [95% CI 1.34 to 2.10], P < 0.00001), periprosthetic fracture (OR 1.42 [95% CI 1.19 to 1.70], P < 0.0001), mechanical loosening (OR 1.54 [95% CI 1.42 to 1.66], P < 0.00001), and dislocation/instability (OR 1.88 [95% CI 1.32 to 2.68], P = 0.0005). Longer LOS and higher cost of care were also found in patients with CUD. CONCLUSION This study strengthens the body of evidence that patients with CUD face higher risk of postoperative complications and greater financial burden after knee and hip arthroplasties. Physicians should inform patients about adverse outcomes and undertake appropriate risk adjustments before elective orthopaedic surgery. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Cheng Ding
- From the Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, The People's Republic of China
| | | | | |
Collapse
|
2
|
Zafrullah F, Raheela F, Ali F, Zafar S, Ayoob N, Majid A, Talpur AS. Spontaneous Coronary Artery Dissection in the Setting of Marijuana: A Case Report. Cureus 2024; 16:e59284. [PMID: 38813308 PMCID: PMC11135382 DOI: 10.7759/cureus.59284] [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: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
This case report presents a detailed examination of spontaneous coronary artery dissection (SCAD) in a 61-year-old Middle Eastern male with a history of marijuana use and essential hypertension. The patient's emergency presentation with loss of consciousness and subsequent diagnostics - including elevated troponins and distinctive electrocardiogram changes - led to the identification of extensive SCAD affecting multiple coronary arteries. The association between marijuana use and cardiovascular pathology is focal in this study, particularly considering the patient's positive test for tetrahydrocannabinol (THC) and significant smoking history. This case highlights the critical need for heightened awareness among clinicians regarding the implications of recreational marijuana use, particularly in individuals with predisposing cardiovascular risk factors. Furthermore, it illustrates the complexity of diagnosing and managing SCAD, a condition that may vary widely in its presentation and severity, necessitating a tailored approach to treatment that considers both the acute manifestations and underlying contributory factors such as substance use.
Collapse
Affiliation(s)
- Fnu Zafrullah
- Interventional Cardiology, Ascension Borgess hHospital, Kalamazoo, USA
| | - Fnu Raheela
- Internal Medicine, Chandka Medical College, Larkana, PAK
- Internal Medicine, Ascension Borgess Hospital, Kalamazoo, USA
| | - Farman Ali
- Medicine, St. John Hospital and Medical Center, Detroit, USA
| | - Shumaila Zafar
- Internal Medicine, Wahid Medical Primary Care, Brooklyn, USA
| | - Nusrat Ayoob
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Abdul Majid
- Internal Medicine, Chandka Medical College, Larkana, PAK
| | - Abdul Subhan Talpur
- Internal Medicine, United Health Services (UHS) Wilson Medical Center, Johnson, USA
| |
Collapse
|
3
|
Khalili MR, Hosseini S, Shirvani M. Bilateral Optic Neuropathy Associated with Acute Inhaled Marijuana Use: Case Report and Review of the Literature. Neuroophthalmology 2024; 48:186-192. [PMID: 38756335 PMCID: PMC11095573 DOI: 10.1080/01658107.2023.2290755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/03/2023] [Indexed: 05/18/2024] Open
Abstract
Marijuana is the most commonly used federally illegal drug in the United States. Acute marijuana use is associated with several cardiovascular and neuropsychological adverse effects. Ocular complications of marijuana abuse are very rare. Herein, we present the first report of bilateral optic neuropathy following smoking marijuana. A 28-year-old man presented to the emergency room with sudden onset of bilateral blurring of the inferior visual field 8 h after smoking marijuana. His best-corrected visual acuity was 20/30 in the right eye and 20/20 in the left eye. Fundus examination revealed blurring of the optic disc margins in both eyes and a splinter haemorrhage in the right eye. Bilateral inferior visual field defects were detected with greater severity on the right side. Optical coherence tomography confirmed the diagnosis of bilateral optic neuropathy. A urine drug screen test was positive for tetrahydrocannabinol, which is the primary active ingredient in cannabinoids. The rest of the neurological examination and imaging were normal. The patient was treated with intravenous corticosteroids and an anti-platelet drug. His vision recovered to 20/20 in both eyes, with complete resolution of the field defect over a follow-up of 6 months. Optic neuropathy following marijuana abuse is unusual. The results of our report emphasise the need for awareness of marijuana-associated optic neuropathy as part of ocular adverse effects of marijuana intoxication.
Collapse
Affiliation(s)
- Mohammad Reza Khalili
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahla Hosseini
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Shirvani
- Geriatric Ophthalmology Research Center, Shahid Sadoughi University of Medical Science, Yazd, Iran
| |
Collapse
|
4
|
Toscano A, Ebo DG, Abbas K, Brucker H, Decuyper II, Naimi D, Nanda A, Nayak AP, Skypala IJ, Sussman G, Zeiger JS, Silvers WS. A review of cannabis allergy in the early days of legalization. Ann Allergy Asthma Immunol 2023; 130:288-295. [PMID: 36384984 PMCID: PMC9991982 DOI: 10.1016/j.anai.2022.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
Cannabis allergy is a burgeoning field; consequently, research is still in its infancy and allergists' knowledge surrounding this topic is limited. As cannabis legalization expands across the world, it is anticipated that there will be an increase in cannabis use. Thus, we hypothesize that a concomitant rise in the incidence of allergy to this plant can be expected. Initiatives aimed at properly educating health care professionals are therefore necessary. This review presents the most up-to-date information on a broad range of topics related to cannabis allergy. Although the clinical features of cannabis allergy are becoming more well described and recognized, the tools available to make a correct diagnosis are meager and often poorly accessible. In addition, research on cannabis allergy is still taking its first steps, and new and potentially groundbreaking findings in this field are expected to occur in the next few years. Finally, although therapeutic approaches are being developed, patient and physician education regarding cannabis allergy is certainly needed.
Collapse
Affiliation(s)
- Alessandro Toscano
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Post-Graduate School of Allergology and Clinical Immunology, University of Milan, Milan, Italy.
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | - Khaldon Abbas
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ine I Decuyper
- Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - David Naimi
- Naval Hospital Camp Pendleton, Oceanside, California
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Texas; Division of Allergy and Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ajay P Nayak
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gordon Sussman
- Department of Medicine and Division of Clinical Immunology & Allergy, University of Toronto, Toronto, Ontario, Canada
| | | | | |
Collapse
|
5
|
Jakob J, Stalder O, Syrogiannouli L, Pletcher MJ, Vittinghoff E, Ning H, Tal K, Rana JS, Sidney S, Lloyd-Jones DM, Auer R. Association between marijuana use and electrocardiographic abnormalities by middle age: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Addiction 2021; 116:583-595. [PMID: 32649034 PMCID: PMC7796923 DOI: 10.1111/add.15188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/03/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the prevalence of electrocardiogram (ECG) abnormalities in marijuana users as an indirect measure of subclinical cardiovascular disease (CVD). DESIGN Longitudinal and cross-sectional secondary data analysis from the CARDIA (Coronary Artery Risk Development in Young Adults) study. SETTING Four communities in the United States. PARTICIPANTS A total of 2585 participants from the 5115 black and white men and women recruited at age 18-30 years in 1985 to 1986 in CARDIA. MEASUREMENTS ECG abnormalities coded as minor and major abnormalities with the Minnesota code of electrocardiographic findings at year 20. Self-reported current (past 30 days) and computed cumulative life-time marijuana use (one 'marijuana-year' corresponds to 365 days of use) through assessments every 2-5 years. We fitted logistic regression models adjusting for sex, race, center, education, age, tobacco smoking, physical activity, alcohol use and body mass index. FINDINGS Among the 2585 participants with an ECG at year 20, mean age was 46, 57% were women, 45% were black; 83% had past exposure to marijuana and 11% were using marijuana currently. One hundred and seventy-three participants (7%) had major abnormalities and 944 (37%) had minor abnormalities. Comparing current with never use in multivariable-adjusted models, the odds ratio (OR) for major ECG abnormalities was 0.60 [95% confidence interval (CI) = 0.32-1.15] and for minor ECG abnormalities 1.21 (95% CI = 0.87-1.68). Results did not change after stratifying by sex and race. Cumulative marijuana use was not associated with ECG abnormalities. CONCLUSION In a middle-aged US population, life-time cumulative and occasional current marijuana use were not associated with increases in electrocardiogram abnormalities. This adds to the growing body of evidence that occasional marijuana use and cardiovascular disease events and markers of subclinical atherosclerosis are not associated.
Collapse
Affiliation(s)
- Julian Jakob
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Odile Stalder
- Clinical Trials Unit (CTU) Bern, University of Bern, Switzerland
| | | | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Hongyan Ning
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jamal S. Rana
- Department of Cardiology, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland,University General Medicine and Public Health Centre, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
| | - Andrea Lavoie
- Department of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Payam Deghani
- Department of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
8
|
Abstract
With the increasing use of marijuana globally, including in pediatric populations, healthcare providers see more adverse health effects associated with this substance. This report details a case presentation of cardiac ischemia in an adolescent male associated with marijuana use. The patient presented with palpitations and chest pain shortly after consuming marijuana. Clinical workup demonstrated anterior ST-segment elevations and troponin elevation with no inflammatory marker elevation or findings of myocarditis on MRI. Extensive drug screening was only positive for marijuana, with a synthetic THC panel negative. These findings resolved after close observation and the patient was discharged in good clinical condition. This case shows a concerning presentation of marijuana-associated cardiac ischemia in an otherwise healthy adolescent, illustrating a potentially severe health concern with an increasingly common substance and demonstrating the need for pediatric centers to have a high index of suspicion for cardiac causes of chest pain when marijuana ingestion is involved even when there are no prior medical or cardiac risk factors.
Collapse
|
9
|
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
| |
Collapse
|
10
|
Jaladi PR, Patel V, Kuduva Rajan S, Rashid W, Madireddy S, Ajibawo T, Imran S, Patel RS. Arrhythmia-related Hospitalization and Comorbid Cannabis Use Disorder: Trend Analysis in US Hospitals (2010-2014). Cureus 2019; 11:e5607. [PMID: 31700720 PMCID: PMC6822885 DOI: 10.7759/cureus.5607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To study the trends of arrhythmia hospitalizations with cannabis use disorders (CUDs) in terms of demographic characteristics and inpatient outcomes. Methods We used the nationwide inpatient sample (NIS) data during the post-legalization period (2010-2014) and included 570,556 arrhythmia inpatients (age, 15-54 years), and 14,426 inpatients had comorbid CUD (2.53%). We used the linear-by-linear association test and independent-sample T-test for assessing the change in hospital outcomes in inpatients with CUD. Results Arrhythmia hospitalizations with CUD increased by 31% (2010-2014). This increasing trend was seen in adults (45-54 years, P < 0.001) and was predominant in males (77.6%). Hypertension (40.6%), hyperlipidemia (17.6%), and obesity (15%) were prevalent medical comorbidities with variable trends over the five years. Among substance use disorders, tobacco (50.9%), and alcohol (31.4%) were major comorbidities with a variable trend (P = 0.003 for each). There was a 71.4% increase in the inpatient mortality rate between 2010 (0.7%) and 2014 (1.2%). The mean length of stay was three days, and the total hospitalization charges have been increasing (P < 0.001), averaging $35,812 per hospital admission. Conclusion Chronic cannabis use or abuse worsens hospitalization outcomes in arrhythmic patients, and more clinical studies are needed to study the causal association between these conditions due to the rising mortality risk.
Collapse
Affiliation(s)
- Paul Rahul Jaladi
- Internal Medicine, Rajiv Gandhi Institute of Medical Sciences, Kadapa, IND
| | | | | | - Wahida Rashid
- Internal Medicine, Dhaka Medical College, Dhaka, BGD
| | | | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | - Sundus Imran
- Neurology, Indiana University School of Medicine, Indianapolis, USA
| | | |
Collapse
|
11
|
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: 11] [Impact Index Per Article: 2.2] [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.
Collapse
Affiliation(s)
| | | | - Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| |
Collapse
|
12
|
Cannabis as a cause of death: A review. Forensic Sci Int 2019; 298:298-306. [DOI: 10.1016/j.forsciint.2019.03.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 11/21/2022]
|
13
|
Hill GED, Izquierdo DA, Boettcher BT, Pagel PS. Chronic Marijuana and Synthetic Cannabinoid-Induced Toxic Myocarditis and End-Stage Cardiomyopathy: Management With Mechanical Circulatory Support as a Bridge-to-Transplantation. J Cardiothorac Vasc Anesth 2018; 33:2508-2512. [PMID: 30606509 DOI: 10.1053/j.jvca.2018.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Graham E D Hill
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - David A Izquierdo
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Brent T Boettcher
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| |
Collapse
|
14
|
Singh A, Saluja S, Kumar A, Agrawal S, Thind M, Nanda S, Shirani J. Cardiovascular Complications of Marijuana and Related Substances: A Review. Cardiol Ther 2018; 7:45-59. [PMID: 29218644 PMCID: PMC5986667 DOI: 10.1007/s40119-017-0102-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Indexed: 12/14/2022] Open
Abstract
The recreational use of cannabis has sharply increased in recent years in parallel with its legalization and decriminalization in several countries. Commonly, the traditional cannabis has been replaced by potent synthetic cannabinoids and cannabimimetics in various forms. Despite overwhelming public perception of the safety of these substances, an increasing number of serious cardiovascular adverse events have been reported in temporal relation to recreational cannabis use. These have included sudden cardiac death, vascular (coronary, cerebral and peripheral) events, arrhythmias and stress cardiomyopathy among others. Many of the victims of these events are relatively young men with few if any cardiovascular risk factors. However, there are reasons to believe that older individuals and those with risk factors for or established cardiovascular disease are at even higher danger of such events following exposure to cannabis. The pathophysiological basis of these events is not fully understood and likely encompasses a complex interaction between the active ingredients (particularly the major cannabinoid, Δ9-tetrahydrocannabinol), and the endo-cannabinoid system, autonomic nervous system, as well as other receptor and non-receptor mediated pathways. Other complicating factors include opposing physiologic effects of other cannabinoids (predominantly cannabidiol), presence of regulatory proteins that act as metabolizing enzymes, binding molecules, or ligands, as well as functional polymorphisms of target receptors. Tolerance to the effects of cannabis may also develop on repeated exposures at least in part due to receptor downregulation or desensitization. Moreover, effects of cannabis may be enhanced or altered by concomitant use of other illicit drugs or medications used for treatment of established cardiovascular diseases. Regardless of these considerations, it is expected that the current cannabis epidemic would add significantly to the universal burden of cardiovascular diseases.
Collapse
Affiliation(s)
- Amitoj Singh
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sajeev Saluja
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Akshat Kumar
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sahil Agrawal
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Munveer Thind
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Sudip Nanda
- 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.
| |
Collapse
|
15
|
Vadivelu N, Kai AM, Kodumudi G, Sramcik J, Kaye AD. Medical Marijuana: Current Concepts, Pharmacological Actions of Cannabinoid Receptor Mediated Activation, and Societal Implications. Curr Pain Headache Rep 2018; 22:3. [PMID: 29349551 DOI: 10.1007/s11916-018-0656-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW The purpose of the following review is to summarize the history and current policies related to marijuana use and prevalence, basic and clinical science pharmacological literature regarding efficacy, subpopulations of concern, and varying policies regarding its use at present. RECENT FINDINGS With the increasingly widespread utilization of marijuana, there is also a growing complexity of public health policy, regulation, and necessity to further assess the medical indications and adverse long-term effects of marijuana use. Health care providers as well as the general public must be prepared to become familiar and up-to-date with medical literature, legislation, and educational material regarding medical marijuana.
Collapse
Affiliation(s)
- Nalini Vadivelu
- Department of Anesthesiology, Yale University, TMP3 333, Cedar Street, New Haven, CT, 06520, USA.
| | - Alice M Kai
- Department of Internal Medicine, NYU Winthrop Hospital, 259 First Street, Mineola, NY, 11501, USA
| | - Gopal Kodumudi
- California Northstate University College of Medicine, 9700 West Taron Drive, Elk Grove, CA, 95757, USA
| | - Julie Sramcik
- Department of Anesthesiology, Yale University, TMP3 333, Cedar Street, New Haven, CT, 06520, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Ave, Suite 656, New Orleans, LA, 70112, USA
| |
Collapse
|
16
|
Robinson J, Somasegar S, Shivapour J, Snyder C. ECG Findings in Pediatric Patients under the Influence of Marijuana. ACTA ACUST UNITED AC 2018. [DOI: 10.26828/cannabis.2018.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
17
|
Brugada Pattern in Diabetic Ketoacidosis: A Case Report and Scoping Study. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2018; 6:173-179. [PMID: 30533520 PMCID: PMC6282764 DOI: 10.12691/ajmcr-6-9-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Brugada syndrome is a rare cardiac arrhythmia which is associated with right bundle branch block pattern (RBBB) and ST-segment elevation in right precordial leads. SCNA5 mutation is the most common genetic abnormality associated with Brugada syndrome. Brugada pattern not related to genetic mutations has been previously reported in the setting of fever, metabolic conditions, lithium use, marijuana and cocaine abuse, ischemia and pulmonary embolism, myocardial and pericardial diseases. Multiple isolated cases of Brugada pattern associated with diabetic ketoacidosis (DKA) have been previously reported. We here present a case of type 1 Brugada pattern in a 23 year-old-male who presented with DKA. Brugada pattern in DKA is attributed to acidosis and multiple electrolyte abnormalities including hyperkalemia which alter ion channel expression in the heart thus leading to Brugada pattern which subsequently resolved with treatment of DKA. In such patients, Brugada pattern is not reproducible on procainamide induction cardiac electrophysiology study (EPS). Our scoping study demonstrates male predominance 20/22 cases of (DELETE this highlighted area) Brugada pattern in DKA, a finding that is consistent with prevalence of this disease among males.
Collapse
|
18
|
Tomé G, Freitas J. Induced Brugada syndrome: Possible sources of arrhythmogenesis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
19
|
Induced Brugada syndrome: Possible sources of arrhythmogenesis. Rev Port Cardiol 2017; 36:945-956. [PMID: 29233646 DOI: 10.1016/j.repc.2017.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 11/24/2022] Open
|
20
|
Bébarová M, Horáková Z, Kula R. Addictive drugs, arrhythmias, and cardiac inward rectifiers. Europace 2017; 19:346-355. [PMID: 27302393 DOI: 10.1093/europace/euw071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/20/2016] [Indexed: 12/30/2022] Open
Abstract
In many addictive drugs including alcohol and nicotine, proarrhythmic effects were reported. This review provides an overview of the current knowledge in this field (with a focus on the inward rectifier potassium currents) to promote the lacking data and appeal for their completion, thus, to improve understanding of the proarrhythmic potential of addictive drugs.
Collapse
|
21
|
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]
|
22
|
Abstract
The growing popularity of medical and recreational consumption of cannabis, especially among the youth, raises immediate concerns regarding its safety and long-terms effects. The cardiovascular effects of cannabis are not well known. Cannabis consumption has been shown to cause arrhythmia including ventricular tachycardia, and potentially sudden death, and to increase the risk of myocardial infarction (MI). These effects appear to be compounded by cigarette smoking and precipitated by excessive physical activity, especially during the first few hours of consumption. Cannabinoids, or the active compounds of cannabis, have been shown to have heterogeneous effects on central and peripheral circulation. Acute cannabis consumption has been shown to cause an increase in blood pressure, specifically systolic blood pressure (SBP), and orthostatic hypotension. Cannabis use has been reported to increase risk of ischemic stroke, particularly in the healthy young patients. The endocannabinoid system (ECS) is currently considered as a promising therapeutic target in the management of several disease conditions. Synthetic cannabinoids (SCs) are being increasingly investigated for their therapeutic effects; however, the value of their benefits over possible complications remains controversial. Despite the considerable research in this field, the benefits of cannabis and its synthetic derivatives remains questionable even in the face of an increasingly tolerating attitude towards recreational consumption and promotion of the therapeutic complications. More efforts are needed to increase awareness among the public, especially youth, about the cardiovascular risks associated with cannabis use and to disseminate the accumulated knowledge regarding its ill effects.
Collapse
Affiliation(s)
- Hemant Goyal
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Hamza H Awad
- Department of community Medicine/Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Jalal K Ghali
- Division of Cardiology, Mercer University School of Medicine, Macon, GA, USA
| |
Collapse
|
23
|
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]
|
24
|
Abstract
Marijuana is currently the most used illicit substance in the world. With the current trend of decriminalization and legalization of marijuana in the US, physicians in the US will encounter more patients using marijuana recreationally over a diverse range of ages and health states. Therefore, it is relevant to review marijuana's effects on human cardiovascular physiology and disease. Compared with placebo, marijuana cigarettes cause increases in heart rate, supine systolic and diastolic blood pressures, and forearm blood flow via increased sympathetic nervous system activity. These actions increase myocardial oxygen demand to a degree that they can decrease the time to exercise-induced angina in patients with a history of stable angina. In addition, marijuana has been associated with triggering myocardial infarctions (MIs) in young male patients. Smoking marijuana has been shown to increase the risk of MI onset by a factor of 4.8 for the 60 minutes after marijuana consumption, and to increase the annual risk of MI in the daily cannabis user from 1.5% to 3% per year. Human and animal models suggest that this effect may be due to coronary arterial vasospasm. However, longitudinal studies have indicated that marijuana use may not have a significant effect on long-term mortality. While further research is required to definitively determine the impact of marijuana on cardiovascular disease, it is reasonable to recommend against recreational marijuana use, especially in individuals with a history of coronary artery disorders.
Collapse
|
25
|
Alonso JV, Teo BHY, Pozo FJFD, Aguayo MA, Sanchez A. Brugada electrocardiogram pattern induced by cannabis; is cannabis safe? Am J Emerg Med 2016; 34:1738.e1-4. [DOI: 10.1016/j.ajem.2015.12.081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 12/27/2015] [Accepted: 12/27/2015] [Indexed: 10/22/2022] Open
|
26
|
Hoch E, Bonnet U, Thomasius R, Ganzer F, Havemann-Reinecke U, Preuss UW. Risks associated with the non-medicinal use of cannabis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:271-8. [PMID: 25939318 DOI: 10.3238/arztebl.2015.0271] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/27/2015] [Accepted: 01/27/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cannabis is the most commonly consumed illicit drug around the world; in Germany, about 4.5% of all adults use it each year. Intense cannabis use is associated with health risks. Evidence-based treatments are available for health problems caused by cannabis use. METHODS Selective literature review based on a search of the PubMed database, with special emphasis on systematic reviews, meta-analyses, cohort studies, randomized controlled trials (RCTs), case-control studies, and treatment guidelines. RESULTS The delta-9-tetrahydrocannabinol content of cannabis products is rising around the world as a result of plant breeding, while cannabidiol, in contrast, is often no longer detectable. Various medical conditions can arise acutely after cannabis use, depending on the user's age, dose, frequency, mode and situation of use, and individual disposition; these include panic attacks, psychotic symptoms, deficient attention, impaired concentration, motor incoordination, and nausea. In particular, intense use of high doses of cannabis over many years, and the initiation of cannabis use in adolescence, can be associated with substance dependence (DSM-5; ICD-10), specific withdrawal symptoms, cognitive impairment, affective disorders, psychosis, anxiety disorders, and physical disease outside the brain (mainly respiratory and cardiovascular conditions). At present, the most effective way to treat cannabis dependence involves a combination of motivational encouragement, cognitive behavioral therapy, and contingency management (level 1a evidence). For adolescents, family therapy is also recommended (level 1a evidence). No pharmacological treatments can be recommended to date, as evidence for their efficacy is lacking. CONCLUSION Further research is needed to elucidate the causal relationships between intense cannabis use and potential damage to physical and mental health. Health problems due to cannabis use can be effectively treated.
Collapse
Affiliation(s)
- Eva Hoch
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Teaching Hospital of the University of Duisburg/Essen, German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Hospital Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Göttingen and DFG Research Center and Cluster of Excellence Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB) of the University Medical Center Göttingen, Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Kreiskrankenhaus Prignitz, Perleberg; Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Martin-Luther- University Halle-Wittenberg, Halle (Saale)
| | | | | | | | | | | |
Collapse
|
27
|
Abstract
Herbal cannabis has been used for thousands of years for medical purposes. With elucidation of the chemical structures of tetrahydrocannabinol (THC) and cannabidiol (CBD) and with discovery of the human endocannabinoid system, the medical usefulness of cannabinoids has been more intensively explored. While more randomized clinical trials are needed for some medical conditions, other medical disorders, like chronic cancer and neuropathic pain and certain symptoms of multiple sclerosis, have substantial evidence supporting cannabinoid efficacy. While herbal cannabis has not met rigorous FDA standards for medical approval, specific well-characterized cannabinoids have met those standards. Where medical cannabis is legal, patients typically see a physician who "certifies" that a benefit may result. Physicians must consider important patient selection criteria such as failure of standard medical treatment for a debilitating medical disorder. Medical cannabis patients must be informed about potential adverse effects, such as acute impairment of memory, coordination and judgment, and possible chronic effects, such as cannabis use disorder, cognitive impairment, and chronic bronchitis. In addition, social dysfunction may result at work/school, and there is increased possibility of motor vehicle accidents. Novel ways to manipulate the endocannbinoid system are being explored to maximize benefits of cannabinoid therapy and lessen possible harmful effects.
Collapse
Affiliation(s)
- Richard J Schrot
- a Veterans' Administration Medical Center, Outpatient Clinic , Tampa , FL , USA ;,b Department of Family Medicine , University of South Florida, Morsani College of Medicine , Tampa , FL , USA
| | - John R Hubbard
- c Psychiatry South , Tuscaloosa , AL , USA ;,d Indian Rivers Mental Health Clinic , Tuscaloosa , AL , USA
| |
Collapse
|
28
|
Marchetti D, Spagnolo A, De Matteis V, Filograna L, De Giovanni N. Coronary thrombosis and marijuana smoking: a case report and narrative review of the literature. Drug Test Anal 2015; 8:56-62. [PMID: 26607055 DOI: 10.1002/dta.1898] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 11/11/2022]
Abstract
We encountered evidence of myocardial infarction due to coronary thrombosis in an autopsy of an occasional marijuana smoker. These findings prompted us to perform a narrative review of the literature to determine when post-mortem toxicological tests may support a temporal relationship between marijuana smoking and cardiovascular disease. Toxicological examination showed the presence of Δ-9-tetrahydrocannabinol, its main metabolite and cannabinol in blood and urine. Quali-quantitative analysis revealed that Δ-9-tetrahydrocannabinol was taken within 2 h of the onset of cardiovascular symptoms, according to circumstantial data. Post-mortem toxicological results must take into account the degradation and post-mortem redistribution of analytes. However, for any inference about the specific cardiovascular triggering effect of Δ-9-tetrahydrocannabinol intake, we maintain that cannabinoid analysis in blood samples must be considered an essential requirement to estimate the time of last intake and avoid incomplete documentation. The literature, combined with the present case report, highlights an association between marijuana use and negative cardiovascular events, although few authors have supported their conclusions with toxicological results. Thus, additional research is needed.
Collapse
Affiliation(s)
- Daniela Marchetti
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| | - Angelico Spagnolo
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| | - Valentino De Matteis
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| | - Laura Filograna
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| | - Nadia De Giovanni
- Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy
| |
Collapse
|
29
|
Clark BC, Georgekutty J, Berul CI. Myocardial Ischemia Secondary to Synthetic Cannabinoid (K2) Use in Pediatric Patients. J Pediatr 2015; 167:757-61.e1. [PMID: 26165442 DOI: 10.1016/j.jpeds.2015.06.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/01/2015] [Accepted: 06/02/2015] [Indexed: 12/28/2022]
Abstract
K2 is a synthetic cannabinoid that has potential cardiovascular side effects, including myocardial ischemia, myocardial infarction, and arrhythmias. Cardiac testing of pediatric patients is often not performed owing to a lack of symptomatology. We report a series of pediatric patients with concern for myocardial ischemia temporally associated with K2 exposure.
Collapse
Affiliation(s)
- Bradley C Clark
- Division of Cardiology, Children's National Health System, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC.
| | - Justin Georgekutty
- Division of Cardiology, Children's National Health System, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Charles I Berul
- Division of Cardiology, Children's National Health System, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| |
Collapse
|
30
|
Gasperi V, Evangelista D, Savini I, Del Principe D, Avigliano L, Maccarrone M, Catani MV. Downstream effects of endocannabinoid on blood cells: implications for health and disease. Cell Mol Life Sci 2015; 72:3235-52. [PMID: 25957591 PMCID: PMC11113859 DOI: 10.1007/s00018-015-1924-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/22/2015] [Accepted: 05/05/2015] [Indexed: 01/02/2023]
Abstract
Endocannabinoids (eCBs), among which N-arachidonoylethanolamine (AEA) and 2-arachidonoylglycerol (2-AG) are the most biologically active members, are polyunsaturated lipids able to bind cannabinoid, vanilloid and peroxisome proliferator-activated receptors. Depending on the target engaged, these bioactive mediators can regulate different signalling pathways, at both central and peripheral levels. The biological action of eCBs is tightly controlled by a plethora of metabolic enzymes which, together with the molecular targets of these substances, form the so-called "endocannabinoid system". The ability of eCBs to control manifold peripheral functions has received a great deal of attention, especially in the light of their widespread distribution in the body. In particular, eCBs are important regulators in blood, where they modulate haematopoiesis, platelet aggregation and apoptosis, as well as chemokine release and migration of immunocompetent cells. Here, we shall review the current knowledge on the pathophysiological roles of eCBs in blood. We shall also discuss the involvement of eCBs in those disorders affecting the haematological system, including cancer and inflammation. Knowledge gained to date underlines a fundamental role of the eCB system in blood, thus suggesting that it may represent a therapeutic promise for a broad range of diseases involving impaired hematopoietic cell functions.
Collapse
Affiliation(s)
- Valeria Gasperi
- Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Daniela Evangelista
- Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Isabella Savini
- Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | | | - Luciana Avigliano
- Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Mauro Maccarrone
- Center of Integrated Research, Campus Bio-Medico University of Rome, Rome, Italy
- European Center for Brain Research (CERC)/Santa Lucia Foundation, Rome, Italy
| | - Maria Valeria Catani
- Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| |
Collapse
|
31
|
Benard V, Rolland B, Messaadi N, Petit A, Cottencin O, Karila L. [Cannabis use: what to do in general practice?]. Presse Med 2015; 44:707-15. [PMID: 26144274 DOI: 10.1016/j.lpm.2014.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 10/26/2014] [Accepted: 11/13/2014] [Indexed: 01/07/2023] Open
Abstract
Cannabis use is now more frequent than alcohol drinking or tobacco smoking among young people (15-34years), whereas it may induce numerous medical aftermaths. Identifying and assessing cannabis use in general practice have become a current public health issue. The two steps of screening consist in spotting risky use of cannabis, and then in checking criteria for cannabis use disorder (CUD). Risky use requires a "brief intervention" by the general practitioner (GP). In case of CUD, the new DSM-5 criteria allow measuring the severity of the subsequent disorder, and listing the medical and social consequences. Using these criteria can help the GP to decide when the patient should be referred to an addiction-specialized unit. The GP has also to spot the different physical and psychiatric complications of cannabis use, in order to coordinate care between the different specialists.
Collapse
Affiliation(s)
- Victoire Benard
- CHU de Lille, université Lille Nord de France, service d'addictologie, 59000 Lille, France
| | - Benjamin Rolland
- CHU de Lille, université Lille Nord de France, service d'addictologie, 59000 Lille, France
| | - Nassir Messaadi
- Université Lille Nord de France, département de médecine générale, 59000 Lille, France
| | - Aymeric Petit
- Hôpital universitaire Bichat-Claude Bernard, service d'addictologie, 75018 Paris, France
| | - Olivier Cottencin
- CHU de Lille, université Lille Nord de France, service d'addictologie, 59000 Lille, France
| | - Laurent Karila
- AP-HP, hôpital Paul-Brousse, université Paris Sud-11, centre d'enseignement, de recherche et de traitement des addictions, Inserm-CEA U1000, 94800 Villejuif, France.
| |
Collapse
|
32
|
Greydanus DE, Kaplan G, Baxter LE, Patel DR, Feucht CL. Cannabis: The never-ending, nefarious nepenthe of the 21st century: What should the clinician know? Dis Mon 2015; 61:118-75. [DOI: 10.1016/j.disamonth.2015.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
33
|
Thomas G, Kloner RA, Rezkalla S. Adverse cardiovascular, cerebrovascular, and peripheral vascular effects of marijuana inhalation: what cardiologists need to know. Am J Cardiol 2014; 113:187-90. [PMID: 24176069 DOI: 10.1016/j.amjcard.2013.09.042] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
Abstract
Marijuana is the most widely used illicit drug, with approximately 200 million users worldwide. Once illegal throughout the United States, cannabis is now legal for medicinal purposes in several states and for recreational use in 3 states. The current wave of decriminalization may lead to more widespread use, and it is important that cardiologists be made aware of the potential for marijuana-associated adverse cardiovascular effects that may begin to occur in the population at a greater frequency. In this report, the investigators focus on the known cardiovascular, cerebrovascular, and peripheral effects of marijuana inhalation. Temporal associations between marijuana use and serious adverse events, including myocardial infarction, sudden cardiac death, cardiomyopathy, stroke, transient ischemic attack, and cannabis arteritis have been described. In conclusion, the potential for increased use of marijuana in the changing legal landscape suggests the need for the community to intensify research regarding the safety of marijuana use and for cardiologists to maintain an awareness of the potential for adverse effects.
Collapse
|
34
|
Greydanus DE, Hawver EK, Greydanus MM, Merrick J. Marijuana: current concepts(†). Front Public Health 2013; 1:42. [PMID: 24350211 PMCID: PMC3859982 DOI: 10.3389/fpubh.2013.00042] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/23/2013] [Indexed: 12/12/2022] Open
Abstract
Marijuana (cannabis) remains a controversial drug in the twenty-first century. This paper considers current research on use of Cannabis sativa and its constituents such as the cannabinoids. Topics reviewed include prevalence of cannabis (pot) use, other drugs consumed with pot, the endocannabinoid system, use of medicinal marijuana, medical adverse effects of cannabis, and psychiatric adverse effects of cannabis use. Treatment of cannabis withdrawal and dependence is difficult and remains mainly based on psychological therapy; current research on pharmacologic management of problems related to cannabis consumption is also considered. The potential role of specific cannabinoids for medical benefit will be revealed as the twenty-first century matures. However, potential dangerous adverse effects from smoking marijuana are well known and should be clearly taught to a public that is often confused by a media-driven, though false message and promise of benign pot consumption.
Collapse
Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University School of Medicine , Kalamazoo, MI , USA
| | - Elizabeth K Hawver
- Department of Pediatric and Adolescent Medicine, Western Michigan University School of Medicine , Kalamazoo, MI , USA
| | - Megan M Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University School of Medicine , Kalamazoo, MI , USA
| | - Joav Merrick
- National Institute of Child Health and Human Development , Jerusalem , Israel ; Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services , Jerusalem , Israel ; Division of Pediatrics, Hadassah Hebrew University Medical Center, Mt. Scopus Campus , Jerusalem , Israel ; Kentucky Children's Hospital, University of Kentucky College of Medicine , Lexington, KY , USA
| |
Collapse
|
35
|
Pacher P, Kunos G. Modulating the endocannabinoid system in human health and disease--successes and failures. FEBS J 2013; 280:1918-43. [PMID: 23551849 PMCID: PMC3684164 DOI: 10.1111/febs.12260] [Citation(s) in RCA: 270] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/11/2013] [Accepted: 03/19/2013] [Indexed: 12/20/2022]
Abstract
The discovery of the endocannabinoid system, comprising the G-protein coupled cannabinoid 1 and 2 receptors (CB1/2), their endogenous lipid ligands or endocannabinoids, and synthetic and metabolizing enzymes, has triggered an avalanche of experimental studies implicating the endocannabinoid system in a growing number of physiological/pathological functions. These studies have also suggested that modulating the activity of the endocannabinoid system holds therapeutic promise for a broad range of diseases, including neurodegenerative, cardiovascular and inflammatory disorders; obesity/metabolic syndrome; cachexia; chemotherapy-induced nausea and vomiting; and tissue injury and pain, amongst others. However, clinical trials with globally acting CB1 antagonists in obesity/metabolic syndrome, and other studies with peripherally-restricted CB1/2 agonists and inhibitors of the endocannabinoid metabolizing enzyme in pain, have introduced unexpected complexities, suggesting that a better understanding of the pathophysiological role of the endocannabinoid system is required to devise clinically successful treatment strategies.
Collapse
Affiliation(s)
- Pál Pacher
- Laboratory of Physiologic Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892-9413, USA.
| | | |
Collapse
|
36
|
Frost L, Mostofsky E, Rosenbloom JI, Mukamal KJ, Mittleman MA. Marijuana use and long-term mortality among survivors of acute myocardial infarction. Am Heart J 2013; 165:170-5. [PMID: 23351819 DOI: 10.1016/j.ahj.2012.11.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 11/11/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Smoking marijuana has been reported to increase risk of myocardial infarction (MI) immediately after use, but less is known about the long-term impact of marijuana use among patients with established coronary disease. METHODS The Determinants of MI Onset Study is a multicenter inception cohort study of myocardial infarction (MI) patients enrolled in 1989 to 1996 and followed up for mortality using the National Death Index. In an initial analysis of 1,935 MI survivors followed up for a median of 3.8 years, we found an increased mortality rate among marijuana users. The current article includes 3,886 Determinants of MI Onset Study patients followed up for up to 18 years. We used Cox proportional hazards models to calculate the hazard ratio and 95% CI for the association between marijuana use and mortality and a propensity score matched analysis to further control confounding. RESULTS Over up to 18 years of follow-up, 519 patients died, including 22 of the 109 reporting marijuana use in the year before their MI. There was no statistically significant association between marijuana use and mortality. Compared with nonusers, the mortality rate was 29% higher (95% CI 0.81-2.05, P = .28) among those reporting any marijuana use. CONCLUSIONS Habitual marijuana use among patients presenting with acute MI was associated with an apparent increased mortality rate over the following 18 years that did not reach nominal statistical significance. Larger studies with repeated measures of marijuana use are needed to definitively establish whether there are adverse cardiovascular consequences of smoking marijuana among patients with established coronary heart disease.
Collapse
|
37
|
Filali T, Lahidheb D, Gommidh M, Jdaida B, Hajlaoui N, Fehri W, Haouala H. Spontaneous multivessel coronary artery dissection associated with cannabis use. J Cardiol Cases 2012; 7:e4-e7. [PMID: 30533106 DOI: 10.1016/j.jccase.2012.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 07/12/2012] [Accepted: 08/03/2012] [Indexed: 11/18/2022] Open
Abstract
Cannabis is the most widely used illicit drug in the world. It is generally considered to be a drug with low toxicity. Nevertheless, there are several case reports of myocardial infarction following cannabis use in otherwise low-risk individuals. We report the first case of a cannabis user presenting with acute coronary syndrome related to multivessel coronary artery dissection.
Collapse
Affiliation(s)
- Thouraya Filali
- Cardiology Department, Military Hospital of Tunis, Montfleury 1008, Tunisia
| | - Dhaker Lahidheb
- Cardiology Department, Military Hospital of Tunis, Montfleury 1008, Tunisia
| | - Mehdi Gommidh
- Cardiology Department, Military Hospital of Tunis, Montfleury 1008, Tunisia
| | - Badii Jdaida
- Cardiology Department, Military Hospital of Tunis, Montfleury 1008, Tunisia
| | - Nadhem Hajlaoui
- Cardiology Department, Military Hospital of Tunis, Montfleury 1008, Tunisia
| | - Wafa Fehri
- Cardiology Department, Military Hospital of Tunis, Montfleury 1008, Tunisia
| | - Habib Haouala
- Cardiology Department, Military Hospital of Tunis, Montfleury 1008, Tunisia
| |
Collapse
|