Marijuana as a trigger of cardiovascular events: Speculation or scientific certainty?

doi:10.1016/j.ijcard.2006.08.001

International Journal of Cardiology

Volume 118, Issue 2, 31 May 2007, Pages 141-144

https://doi.org/10.1016/j.ijcard.2006.08.001 Get rights and content

Abstract

Marijuana is the most widely used illicit substance in the United States. Cardiovascular complications in association with marijuana use have been reported during the past three decades. In view of the elevated public interest in this drug's role in pharmacotherapy in the recent years and the aging population of long-term marijuana users from the late 1960s, encounters with marijuana-related cardiovascular adversities may be silently on the rise. The purpose of this article is to increase awareness of the potential of marijuana to lead to cardiovascular disease. Here, we will discuss the physiologic effects of marijuana and include a comprehensive review of the studies and case reports that provide supportive evidence for marijuana as a trigger of adverse cardiovascular events, including tachyarrhythmias, acute coronary syndrome, vascular complications, and even congenital heart defects.

Introduction

Marijuana is the most widely used illicit substance in the United States [1]. Its self-reported use is greatest among young adults between 18 and 25 years of age, and by some it has been perceived as safe and possibly even therapeutic [1]. Nevertheless, cardiovascular complications in association with marijuana have been reported during the past three decades. As early as 1979, Charles et al. [2] reported the case of a non-Q-wave myocardial infarction in a healthy 25-year-old man with normal coronary arteries after smoking marijuana. Since then, there have been other similar case reports on this association and several mechanisms of action have been proposed.

In view of the elevated public interest in this drug's role in pharmacotherapy in the recent years and the aging population of long-term marijuana users from the late 1960s, encounters with marijuana-related cardiovascular adversities may be silently on the rise. The purpose of this paper is to increase awareness of the potential of marijuana to lead to cardiovascular disease.

Section snippets

Physiological effects of marijuana use

Much of what is known about the physiologic effects of marijuana comes from experiments with Δ⁹-tetrahydrocannibol (THC), the major active cannabinoid in marijuana [3]. Whether delivered intravenously or through smoking, THC can result in a rapid and substantial dose-dependent increase in heart rate by as much as 20–100% and a modest increase in blood pressure [3], [4], [5], [6], [7], [8], [9], [10]. These effects are believed to be mediated through sympathetic stimulation and reduced

Marijuana use and cardiovascular disease outcomes

Table 1 outlines several proposed mechanisms by which marijuana and THC might contribute to the development of cardiovascular events [3], [13], [14], [15]. Furthermore, in view of the strong association between tobacco and marijuana use, it would be imperative to recognize this relationship whenever analyzing the association between marijuana use and tobacco-related disorders such as cardiovascular disease [3], [15].

Conclusions

Marijuana use by older people, particularly those with some degree of coronary artery or cerebrovascular disease, poses greater risks due to the resulting increase in catecholamines, cardiac workload, and carboxyhemoglobin levels, and concurrent episodes of profound postural hypotension. Indeed, marijuana may be a much more common cause of myocardial infarction than is generally recognized. In day-to-day practice, a history of marijuana use is often not sought by many practitioners, and even

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Citation Excerpt :
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Synthetic cannabinoids cannot be detected on a standard urine drug screen (UDS), making them a convenient drug of abuse. We report the first case of ST elevation myocardial infarction (STEMI) in a young patient due to coronary artery thrombosis secondary to synthetic cannabinoid use and concurrent COVID-19 infection. A 38-year-old previously healthy male developed severe chest pain and was found to have anterior STEMI and COVID-19 infection. Coronary angiography showed acute thrombotic occlusion of the mid-left anterior descending artery that was managed with thrombectomy and stent placement. He only required supportive care for COVID-19. A comprehensive literature search revealed 34 additional cases of STEMI with synthetic cannabinoid use; majority were males (97%) with mean age of 29 years. 29 patients (85.3%) underwent coronary angiography and majority had left anterior descending artery (LAD) involvement (55%), with 13 (44.8%) undergoing stent placement. We highlight STEMI as a potentially lethal complication of synthetic cannabinoids; prompt angiography may be lifesaving.
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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.
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.
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.
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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La nicotine est la substance psychoactive spécifique du tabac alors que le tétrahydrocannabinol (THC) est spécifique du cannabis. La technique d’inhalation de la fumée de cannabis diffère de celle du tabac : volume des bouffées plus important, inhalation plus profonde, durée de rétention pulmonaire plus importante. La dépendance au seul cannabis est difficile à évaluer, ces deux produits étant le plus souvent consommés de façon concomitante. Les principales complications somatiques du cannabis sont similaires à celles du tabac : respiratoires, cardiovasculaires, endocriniennes et stomatologiques. Certaines complications digestives sont spécifiques du cannabis (hyperémèse cannabique). Les troubles psychiques du cannabis peuvent être aigus (modifications de la perception du temps et des distances ; perturbations sensorielles ; diminution de la vigilance ; troubles thymiques et dissociatifs ; hallucinations et délires ; diminution des performances intellectuelles, motrices et cognitives ; perturbations de la mémoire immédiate ; crises d’angoisse aiguë et attaques de panique) ou chroniques (syndrome amotivationnel, syndrome de désorganisation de la pensée, augmentation du risque d’apparition ou d’aggravation de la schizophrénie). Enfin, citons les accidents de la circulation routière et les accidents du travail. Les cannabinoïdes de synthèse ont des effets psychiques et somatiques majorés en raison de leur plus importante affinité pour les récepteurs cannabinoïdes centraux.
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ReviewMarijuana as a trigger of cardiovascular events: Speculation or scientific certainty?

Abstract

Introduction

Section snippets

Physiological effects of marijuana use

Marijuana use and cardiovascular disease outcomes

Conclusions

Chest

Am Heart J

J Adolesc Health Care

Int J Cardiol

Int J Cardiol

Am Heart J

Drug Alcohol Depend

Int J Cardiol

Forensic Sci Int

Ann Emerg Med

Rev Med Interne

National Household Survey on Drug Abuse, Rockville, MD

Myocardial infarction and marijuana

Clin Toxicol

Cardiovascular consequences of marijuana use

J Clin Pharmacol

Cardiovascular system effects of marijuana

J Clin Pharmacol

Marihuana smoking: cardiovascular effects in man and possible mechanisms

N Engl J Med

Cardiovascular effects of delta-9-tetrahydrocannabinol in man

Clin Pharmacol Ther

Health aspects of cannabis

Pharmacol Rev

Cardiovascular effects of intravenous delta-9-tetrahydrocannabinol: autonomic nervous mechanisms

Clin Pharmacol Ther

Effects of marihuana and placebo marihuana smoking on hemodynamics in coronary disease

Clin Pharmacol Ther

Middle cerebral artery velocity during upright posture after marijuana smoking

Acta Psychiatr Scand

Review
Marijuana as a trigger of cardiovascular events: Speculation or scientific certainty?