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Source: Thailand Medical News  Jan 21, 2020  4 years, 1 month, 1 day, 9 hours, 43 minutes ago

Healthcare Professionals Concerned As More Than Two Million Patients With Cardiovascular Disease Report Use Of Cannabis In America

Healthcare Professionals Concerned As More Than Two Million Patients With Cardiovascular Disease Report Use Of Cannabis In America
Source: Thailand Medical News  Jan 21, 2020  4 years, 1 month, 1 day, 9 hours, 43 minutes ago
As more states in the US begin to legalize cannabis for medicinal and recreational use and more cannabis products become available for consumption, cannabis's cardiovascular effects are not well understood. In a review article published in the Journal of the American College of Cardiology, a team led by investigators at Brigham and Women's Hospital reveals that more than 2 million adults with cardiovascular disease report that they have used or are currently using cannabis. Observational studies have linked cannabis use to a range of cardiovascular risks, including stroke, arrhythmia and diseases that make it hard for the heart muscle to pump properly. The investigators encourage physicians to ask their patients about cannabis use, which can interfere with other medications that a cardiology patient might be prescribed.

Corresponding author Dr Muthiah Vaduganathan, MD, MPH, a cardiologist at the Brigham told Thailand Medical News, "This was eye-opening for us. We're experiencing an epidemiological shift. More patients are curbing their cigarette smoking, and we're seeing big improvements in cardiovascular health for those who quit. In contrast, we're seeing an accelerating use of cannabis and now, for the first time, cannabis users are exceeding cigarette smokers in the U.S. We now need to turn our attention and public health resources toward understanding the safety profile of its use."

Currently, cannabis is classified as a schedule I drug by the U.S. Drug Enforcement Agency, meaning that its use in research is highly restricted and researchers must navigate approvals through local, state and federally agencies. This means that even as individual states legalize its use, randomized, clinical trials to understand its health effects are not feasible, given the number of restrictions in place. However, researchers can use real-world data to study its effects, for instance, by comparing before-and-after statistics on health in states where cannabis has been legalized for recreational use, medical use or both. As cannabis use increases in the US, large epidemiologic studies may clarify the relationship between cannabis and cardiovascular risk.

Dr Vaduganathan, along with Dr Ersilia M. DeFilippis, MD, a former internal medicine resident at the Brigham who is now a cardiology fellow at Columbia University Irving Medical Center, conducted a query of data from the National Health and Nutrition Examination Survey (NHANES) to estimate cannabis use among U.S. patients with cardiovascular disease. They estimated that 2 million (2.3 percent) of the 89.6 million adults who reported cannabis use had cardiovascular disease.
"Cannabis use, both recreational and medical, is increasing nationally yet many of its cardiovascular effects remain poorly understood," said lead author DeFilippis. "In our NHANES query, we estimated that 2 million adults with cannabis use had cardiovascular disease in 2015-2016. Since that time, additional states have passed legislature related to cannabis  so its use may have increased even further. Notably, many of our cardiology patients are on medications that can interact with cannabis  in unpredictable ways depending on the formulation. This highlights that we need more data so that we can better counsel providers as well as patients."

Dr DeFilippis and Dr Vaduganathan collaborated with colleagues in cardiology and pharmacology to better understand the implications of increased cannabis use. In their review paper, the authors outline the ways that the components and compounds in cannabis may affect the heart and other tissue at a molecular level and the drug interactions that cannabis  can have with drugs that are commonly given to cardiology patients. They also describe observational studies that suggest a connection between cannabis and heart conditions, including:
  • Smoking-related cardiotoxicity: Many of the same cardiotoxic chemicals found in cigarettes are also found in cannabis smoke.
  • Coronary artery disease: Cannabis inhalation can increase heart rate and blood pressure and may be a trigger of a heart attack.
  • Arrhythmias: Cannabis use has been associated with abnormal heart rhythms, including atrial fibrillation.
  • Cerebrovascular disease: Surveys have found that cannabis smokers were three times more likely to experience a cerebrovascular event, such as a stroke. Among 334 patients younger than 45 who had experienced a stroke, 17 percent were cannabis users.
The researchers urge clinicians to ask their patients about cannabis use and, if the patient is currently using cannabis, to consult with a pharmacist about prescriptions. Cardiovascular specialists should also have open discussions with patients, acknowledging the limited scientific data but potential cardiovascular hazards of cannabis use, the authors write.

Dr Vaduganathan added, "In the clinic, patients often ask us about the safety of cannabis use and we're pressed to offer the best scientific evidence. Our current approach is that patients who are at high risk of cardiovascular events should be counseled to avoid or at least minimize cannabis use, and that rigorous scientific research should be conducted to further inform recommendations for patient care."

Reference : DeFilippis, EM et al. "Marijuana Use in Patients with Cardiovascular Disease" Journal of the American College of Cardiology DOI: 10.1016/j.jacc.2019.11.025


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