Physicians' Academy for Cardiovascular Education

Marijuana use may increase risk of CV complications in young adults

Jouanjus E et al., J Am Heart Assoc. 2014 - J Am Heart Assoc. 2014 Apr 23;3(2)

 
Cannabis use: signal of increasing risk of serious cardiovascular disorders

 
Jouanjus E, Lapeyre-Mestre M, Micallef J; French Association of the Regional Abuse and Dependence Monitoring Centres (CEIP-A) Working Group on Cannabis Complications
J Am Heart Assoc. 2014 Apr 23;3(2):e000638. doi: 10.1161/JAHA.113.000638
 

Background

Cannabis use has recently been added to the list of potential triggers for myocardial infarction (MI) [1], and it has been related to ischemic stroke associated with drugs with abuse potential [2].
Communication about the potential therapeutic properties of cannabinoids may have contributed to an image of a safe or even healthy substance to use [3]. It is now suggested, however, that cannabis and tobacco together accelerate the occurrence of coronary syndromes in patients with coronary history, as compared to tobacco alone [4]. The risk of MI appeared to be acutely increased by cannabis use [5], as well as other serious cardiovascular (CV) complications in young, apparently healthy, cannabis users [6].
The French Addictovigilance Network (FAN) aims to achieve reliable surveillance of abuse and pharmacodependence cases. Remarkable cases of cannabis-related CV disorders have been reported to FAN in recent years. This study investigated all cases reported between 2006 and 2010, to evaluate whether there is a signal of increasing risk of CV complications related to cannabis use in France.
 

Main results

  • 1979 cannabis-related complications were spontaneously reported, of which 35 were of cardiovascular nature. In 2006 1.1% were CV complications, while in 2010 3.6% were CV.
  • 30 out of 35 cases were men. Mean age was 34.3 years old (SD: 8.8 years).
  • 9 subjects had a personal CV history, and 7 subjects had familial CV history.
  • Cannabis exposure was actual, recent, and regular or daily in 8,6 and 16 patients respectively. Toxicologic analyses was performed in 13 cases and confirmed the presence of Δ9-tetra-Hydrocannabinol (THC). In the remaining 22 patients, cannabis, alcohol and/or other substances were mentioned in the medical file.
  • Both cardiac (20 acute coronary syndromes and 2 heart rate disorders) and extracardiac complications (affecting cerebral arteries, including acute cerebral angiopathy, transient cortical blindness and spasm of cerebral artery, or lower limb or juvenile arteriopathies and Buerger-like disease) occurred. 9 cases resulted in death.
 

Conclusion

During the studied period, the proportion of CV complications rose from 1.1% to 3.6% of all cannabis-related complications reported to the French Addictovigilance Network. All complications were serious.
Although reporting of all serious cases related to drug abuse and dependence is compulsory In France, these results likely suffer from underestimation due to underreporting. Since spontaneous reporting is important in identifying signals, the increase in reporting of cannabis-related CV complications observed in this study could indicate that cannabis is a possible risk factor  for CV disease in young adults, in line with previous findings. A prospective study should evaluate whether cannabis may indeed trigger CV complications.

Editorial comment [7]
Although the role of medical marijuana is indisputable in patients suffering from chronic, debilitating pain, widespread legalisation of marijuana for recreational purposes raises important questions regarding safety. Several studies have shed light on adverse cardiovascular effects of marijuana, the most striking of which reported incidence in very young patients with no other risk factors. A mandate to report CV effects may be a reasonable strategy to gather additional safety data, as described by Jouanjus. Despite the probable underreporting of cannabis-use , this paper suggests a signal linking cannabis use to CV events. The authors of this editorial suggest adoption of a national system for mandatory reporting of medical complications to marijuana use, to determine the safety of the drug, before it is widely legalised for recreational use. Healthcare providers and the public need to be educated about the potential risk of developing a CV event associated with the use of marijuana.
 
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References

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7. Rezkalla S, Kloner RA. Recreational Marijuana Use: Is it Safe for Your Patient? J Am Heart Assoc. 2014;3:e000904; April 23, 2014