Meeting NewsPerspective

Marijuana use linked to higher risk for stroke, HF

WASHINGTON — A new study presented at the American College of Cardiology Scientific Session highlights elevated risk for stroke, HF and other CV events with marijuana use.

As of the 2016 U.S. presidential election, 28 states and Washington, D.C., have legalized marijuana for medicinal and/or recreational uses, according to the study background.

Aditi Kalla

“From a physician’s perspective, we now need to be more knowledgeable about the risks and benefits of cannabis, as patients in these states may inquire about the use of it or even ask us for prescriptions of it,” Aditi Kalla, MD, cardiology fellow at Einstein Medical Center in Philadelphia, said during a press conference.

Kalla and colleagues collected 2009-2010 data from the National Inpatient Sample Database, when legalization of marijuana was less common. The researchers focused on participants aged 18 to 55 years who reported using marijuana (n = 316,397 [1.5%]; mean age: 33 years; 60% men) or reported no use (n = 20,499,215 [98.5%]; mean age: 26 years; 38% men).

Compared with no use, those who reported using marijuana were more likely to have CV events including HF (1.4% vs. 1.2%; P < .01), stroke (1.03% vs. 0.62%; P < .0001), sudden cardiac death (0.21% vs. 0.17%; P = .02) and CAD (5% vs. 4.6%; P < .0001), according to the findings.

After adjustment for sex, age, diabetes, hypertension, CAD, hyperlipidemia, and tobacco and alcohol use, marijuana was an independent predictor of HF (OR = 1.1; 95% CI, 1.02-1.18) and cerebrovascular accidents (OR = 1.26; 95% CI, 1.16–1.36).

“Even when we corrected for known risk factors, we still found a higher rate of both stroke and [HF] in these patients, so that leads us to believe that there is something else going on besides just obesity or diet-related [CV] side effects,” Kalla said in a press release. “More research will be needed to understand the pathophysiology behind this effect.” – by Darlene Dobkowski

Reference:

Kalla A, et al. Abstract 1187-055. Presented at: American College of Cardiology Scientific Session; March 17-19, 2017; Washington, D.C.

Disclosure : Kalla reports no relevant financial disclosures.

WASHINGTON — A new study presented at the American College of Cardiology Scientific Session highlights elevated risk for stroke, HF and other CV events with marijuana use.

As of the 2016 U.S. presidential election, 28 states and Washington, D.C., have legalized marijuana for medicinal and/or recreational uses, according to the study background.

Aditi Kalla

“From a physician’s perspective, we now need to be more knowledgeable about the risks and benefits of cannabis, as patients in these states may inquire about the use of it or even ask us for prescriptions of it,” Aditi Kalla, MD, cardiology fellow at Einstein Medical Center in Philadelphia, said during a press conference.

Kalla and colleagues collected 2009-2010 data from the National Inpatient Sample Database, when legalization of marijuana was less common. The researchers focused on participants aged 18 to 55 years who reported using marijuana (n = 316,397 [1.5%]; mean age: 33 years; 60% men) or reported no use (n = 20,499,215 [98.5%]; mean age: 26 years; 38% men).

Compared with no use, those who reported using marijuana were more likely to have CV events including HF (1.4% vs. 1.2%; P < .01), stroke (1.03% vs. 0.62%; P < .0001), sudden cardiac death (0.21% vs. 0.17%; P = .02) and CAD (5% vs. 4.6%; P < .0001), according to the findings.

After adjustment for sex, age, diabetes, hypertension, CAD, hyperlipidemia, and tobacco and alcohol use, marijuana was an independent predictor of HF (OR = 1.1; 95% CI, 1.02-1.18) and cerebrovascular accidents (OR = 1.26; 95% CI, 1.16–1.36).

“Even when we corrected for known risk factors, we still found a higher rate of both stroke and [HF] in these patients, so that leads us to believe that there is something else going on besides just obesity or diet-related [CV] side effects,” Kalla said in a press release. “More research will be needed to understand the pathophysiology behind this effect.” – by Darlene Dobkowski

Reference:

Kalla A, et al. Abstract 1187-055. Presented at: American College of Cardiology Scientific Session; March 17-19, 2017; Washington, D.C.

Disclosure : Kalla reports no relevant financial disclosures.

    Perspective

    This is an important study. It utilizes a very large database of more than 300,000 cannabis users and more than 20 million non-cannabis users, and found that after multivariate regression analysis, taking into account other risk factors, using marijuana is associated with increases in HF and cerebrovascular events. Of note is that cannabis use was also associated with hypertension, tobacco use, alcohol use and obesity. Without taking into account other risk factors, it was associated with more CAD and sudden death. This is one of the largest databases on the subject that is available.

    These findings have immense implications in clinical practice. More and more states are legalizing marijuana for medicinal and recreational use. There is a perception that the use of marijuana is perfectly safe. However, there have been a number of reports linking marijuana use to acute MI and stroke. Practitioners must be made aware of these links and be cautious in their prescriptions of medical marijuana, especially if there are already underlying heart disease and/or risk factors for heart disease. In addition, if a patient presents with HF or stroke, it is important to think about asking about marijuana use.

    Consumers also need to be educated about the potential harmful effects marijuana use may have on the CV and cerebral systems. Most consumers are not aware of the findings of this and other studies. More research is needed into the effects of marijuana on the heart, brain and vasculature.

    We are going to be seeing more and more individuals using marijuana as it is legalized for recreational use. Health care providers need to know both the potential deleterious as well as beneficial effects of this substance.

    • Robert A. Kloner , MD, PhD
    • Vice President of Translation
      Huntington Medical Research Institutes, Pasadena, Calif.
      Professor of Medicine
      University of Southern California Keck School of Medicine

    Disclosures: Kloner reports no relevant financial disclosures.

    Perspective
    Abraham_William

    William T. Abraham

    The general effects of marijuana on the CV system are known. Marijuana use increases the heart rate by as much as 100%. This occurs acutely while ingesting marijuana, but the effect may last for hours. This increases the workload of the heart because it stresses the heart, thus increasing the likelihood of CV events. Other CV effects of marijuana include chest pain, MI, arrhythmias and weakening of the heart.

    This new study indicates that there is also a strong association between marijuana use and stroke and HF. There was a 26% increase in the risk for stroke and a 10% increase in the risk for HF. The study is powerful because it is large, coming from an evaluation of 20 million medical records from more than 1,000 U.S. hospitals.

    Marijuana use history should become more routinely assessed in patients presenting with stroke and HF, and perhaps with other CV disorders such as MI, as this may represent a modifiable risk factor. This may be particularly important in young people who do not generally have strokes or HF, where the cause is often unexplained. Finally, counseling of patients who are marijuana users on the potential CV risks may allow them to make a more informed decision about ongoing marijuana use.

    As the medicinal use of marijuana expands, it would be appropriate to treat it more like a medicine and pursue randomized controlled trials to better define the risks and benefits of marijuana use and its risk/benefit relationship.

    • William T. Abraham , MD, FACP, FACC
    • Director, Division of Cardiovascular Medicine
      Professor of Internal Medicine, Physiology and Cell Biology
      The Ohio State University Wexner Medical Center

    Disclosures: Abraham reports no relevant financial disclosures.

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