Nav: Home

More than 2 million patients with heart disease report use of marijuana

January 20, 2020

Boston, MA -- Even as more states begin to legalize marijuana for medicinal and recreational use and more marijuana products become available for consumption, marijuana'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 marijuana. Observational studies have linked marijuana 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 marijuana use, which can interfere with other medications that a cardiology patient might be prescribed.

"This was eye-opening for us," said corresponding author Muthiah Vaduganathan, MD, MPH, a cardiologist at the Brigham. "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 marijuana and now, for the first time, marijuana 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."

Marijuana 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 marijuana has been legalized for recreational use, medical use or both. As marijuana use increases in the US, large epidemiologic studies may clarify the relationship between marijuana and cardiovascular risk.

Vaduganathan, along with 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 marijuana use among U.S. patients with cardiovascular disease. They estimated that 2 million (2.3 percent) of the 89.6 million adults who reported marijuana use had cardiovascular disease.

"Marijuana 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 marijuana use had cardiovascular disease in 2015-2016. Since that time, additional states have passed legislature related to marijuana so its use may have increased even further. Notably, many of our cardiology patients are on medications that can interact with marijuana 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."

DeFilippis and Vaduganathan collaborated with colleagues in cardiology and pharmacology to better understand the implications of increased marijuana use. In their review paper, the authors outline the ways that the components and compounds in marijuana may affect the heart and other tissue at a molecular level and the drug interactions that marijuana can have with drugs that are commonly given to cardiology patients. They also describe observational studies that suggest a connection between marijuana and heart conditions, including:
  • Smoking-related cardiotoxicity: Many of the same cardiotoxic chemicals found in cigarettes are also found in marijuana smoke.

  • Coronary artery disease: Cannabis inhalation can increase heart rate and blood pressure and may be a trigger of a heart attack.

  • Arrhythmias: Marijuana use has been associated with abnormal heart rhythms, including atrial fibrillation.

  • Cerebrovascular disease: Surveys have found that marijuana 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 authors urge clinicians to ask their patients about marijuana use and, if the patient is currently using marijuana, 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 marijuana use, the authors write.

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

Paper cited: 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

Brigham Health, a global leader in creating a healthier world, consists of Brigham and Women's Hospital, Brigham and Women's Faulkner Hospital, the Brigham and Women's Physicians Organization and many related facilities and programs. With more than 1,000 inpatient beds, approximately 60,000 inpatient stays and 1.7 million outpatient encounters annually, Brigham Health's 1,200 physicians provide expert care in virtually every medical and surgical specialty to patients locally, regionally and around the world. An international leader in basic, clinical and translational research, Brigham Health has nearly 5,000 scientists, including physician-investigators, renowned biomedical researchers and faculty supported by over $700 million in funding. The Brigham's medical preeminence dates back to 1832, and now, with 19,000 employees, that rich history is the foundation for its commitment to research, innovation, and community. Boston-based Brigham and Women's Hospital is a teaching affiliate of Harvard Medical School and dedicated to educating and training the next generation of health care professionals. For more information, resources, and to follow us on social media, please visit brighamandwomens.org.

Brigham and Women's Hospital

Related Cardiovascular Disease Articles:

Changes by income level in cardiovascular disease in US
Researchers examined changes in how common cardiovascular disease was in the highest-income earners compared with the rest of the population in the United States between 1999 and 2016.
Fighting cardiovascular disease with acne drug
Researchers from the European Molecular Biology Laboratory (EMBL) in Heidelberg and Stanford University have found the cause of dilated cardiomyopathy - a leading cause of heart failure - and identified a potential treatment for it: a drug already used to treat acne.
A talk with your GP may prevent cardiovascular disease
Having a general practitioner (GP) who is trained in motivational interviewing may reduce your risk of getting cardiovascular disease.
Dilemma of COVID-19, aging and cardiovascular disease
Whether individuals should continue to take angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the context of coronavirus disease 2019 (COVID-19) is discussed in this article.
Air pollution linked to dementia and cardiovascular disease
People continuously exposed to air pollution are at increased risk of dementia, especially if they also suffer from cardiovascular diseases, according to a study at Karolinska Institutet in Sweden published in the journal JAMA Neurology.
New insights into the effect of aging on cardiovascular disease
Aging adults are more likely to have - and die from - cardiovascular disease than their younger counterparts.
Premature death from cardiovascular disease
National data were used to examine changes from 2000 to 2015 in premature death (ages 25 to 64) from cardiovascular disease in the United States.
Ultrasound: The potential power for cardiovascular disease therapy
In the current issue of Cardiovascular Innovations and Applications volume 4, issue 2, pp.
Despite the ACA, millions of Americans with cardiovascular disease still can't get care
Cardiovascular disease (CVD) is the leading cause of death for Americans, yet millions with CVD or cardiovascular risk factors (CVRF) still can't access the care they need, even years after the implementation of the Affordable Care Act (ACA).
Excess weight and body fat cause cardiovascular disease
In the first Mendelian randomization study to look at this, researchers have found evidence that excess weight and body fat cause a range of heart and blood vessel diseases (rather than just being associated with it).
More Cardiovascular Disease News and Cardiovascular Disease Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.