Healthcare Professionals Concerned As More Than Two Million Patients With Cardiovascular Disease Report Use Of Cannabis In America
As more states in the US begin to legalize cannabis
for medicinal and recreational use and more cannabis
products become available for consumption, cannabis
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
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."
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
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
use, both recreational and medical, is increasing nationally yet many of its cardiovascula
r 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 cardiolog
y 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
- 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