Marijuana use and short-term outcomes in patients hospitalized for acute myocardial infarction

In-hospital outcomes following an acute coronary syndrome in patients with recent cannabis use

BACKGROUND

The prevalence and short-term cardiovascular consequences of recent cannabis use in patients admitted to an intensive cardiac care unit for acute coronary syndrome is not well established.

AIMS

To assess the prevalence of recent cannabis use detected by prospective systematic screening, and its prognostic value in predicting the occurrence of in-hospital major adverse events in consecutive patients with acute coronary syndrome.

METHODS

From 07 to 22 April 2021, all consecutive patients admitted to an intensive cardiac care unit in 39 centres throughout France were studied prospectively. Systematic recreational drug screening was performed on admission by urine assay in all patients. The primary outcome was the prevalence of recent cannabis use. The secondary outcome was in-hospital major adverse events, defined by death, resuscitated cardiac arrest and cardiogenic shock requiring medical or mechanical haemodynamic support.

RESULTS

A total of 772 patients were hospitalized for acute coronary syndrome (mean age 64±13years; 74% male). Among those, 86 patients (11.1%) had a positive urine test for cannabis. Patients with cannabis detected were younger (53±12 vs. 65±12years, respectively; P<0.001) and were more frequently male (88% vs. 72%, respectively; P=0.001). After a median hospitalization duration of 2days, 33 (4.3%) in-hospital major adverse events occurred. The detection of cannabis was associated with a higher rate of in-hospital major adverse events after adjustment for prior co-morbidities (odds ratio 3.28; P=0.015) and after adjustment for known predictors of severity (odds ratio 3.68; P=0.009).

CONCLUSIONS

The prevalence of recent cannabis use in patients hospitalized for acute coronary syndrome was 11.1%. The detection of recent cannabis use was independently associated with a higher occurrence of in-hospital major adverse events.

Arrhythmias and cannabis use: A comprehensive overview

The increasing prevalence of cannabis use, with an estimated 219 million users globally, underscores the need to examine its potential health impacts. This review focuses on the arrhythmogenic properties of cannabis, particularly considering its active component, tetrahydrocannabinol, and its interactions with the endocannabinoid system. Epidemiological data and multiple studies indicate a significant association between cannabis use and various arrhythmias, particularly atrial fibrillation. The risk is notably higher among younger users and males. Additionally, case reports have linked cannabis use to other arrhythmias such as ventricular tachycardia and ventricular fibrillation, especially in individuals with underlying cardiac abnormalities. This review also discusses the arrhythmogenic potential of synthetic cannabinoids, which are more potent than natural tetrahydrocannabinol. Despite some studies suggesting no significant difference in arrhythmia burden between cannabis users and nonusers, the preponderance of evidence supports a correlation between cannabis use and increased arrhythmia risk. Given the rising tetrahydrocannabinol content in cannabis products and the limited data on the long-term cardiovascular effects, this review underscores the need for large-scale prospective studies. Until more comprehensive data are available, it is advisable for patients with channelopathies, structural heart disease, or prior myocardial infarction to avoid cannabis use.

Contemporary nationwide trends in major adverse cardiovascular events in young cannabis users without concomitant tobacco, alcohol, cocaine use

BACKGROUND

Cannabis use has increased among young individuals in recent years. Although dependent cannabis use disorder (CUD) has been associated with various cardiac events, its effects on young adults without concurrent substance use remain understudied.

AIM

To examine trends in hospitalizations for major adverse cardiac and cerebrovascular events (MACCE) in this cohort.

METHODS

We used the National Inpatient Sample (2016-2019) to identify hospitalized young individuals (18-44 years), excluding those with concurrent substance usage (tobacco, alcohol, and cocaine). They were divided into CUD+ and CUD-. Using International Classification of Diseases-10 codes, we examined the trends in MACCE hospitalizations, including all-cause mortality (ACM), acute myocardial infarction (AMI), cardiac arrest (CA), and acute ischemic stroke (AIS).

RESULTS

Of 27.4 million hospitalizations among young adults without concurrent substance abuse, 4.2% (1.1 million) had co-existent CUD. In CUD+ group, hospitalization rates for MACCE (1.71% vs 1.35%), AMI (0.86% vs 0.54%), CA (0.27% vs 0.24%), and AIS (0.49% vs 0.35%) were higher than in CUD- group (P < 0.001). However, rate of ACM hospitalizations was lower in CUD+ group (0.30% vs 0.44%). From 2016 to 2019, CUD+ group experienced a relative rise of 5% in MACCE and 20% in AMI hospitalizations, compared to 22% and 36% increases in CUD- group (P < 0.05). The CUD+ group had a 13% relative decrease in ACM hospitalizations, compared to a 10% relative rise in CUD- group (P < 0.05). However, when adjusted for confounders, MACCE odds among CUD+ cohort remain comparable between 2016 and 2019.

CONCLUSION

The CUD+ group had higher rates of MACCE, but the rising trends were more apparent in the CUD- group over time. Interestingly, the CUD+ group had lower ACM rates than the CUD- group.

Unmasking the cannabis paradox: in-hospital outcomes of cannabis users admitted with acute myocardial infarction over a 20-year period in the United States

Introduction

Cannabis is increasingly becoming a socially acceptable substance, with multiple countries having legalised its consumption. Epidemiological studies have demonstrated an association between cannabis use and an increased risk of developing coronary artery disease. However, there is a lack of studies about the influence of cannabis consumption on the outcomes following acute myocardial infarction (AMI).

Material and methods

We retrospectively analysed hospitalised patients with a primary diagnosis of AMI from the 2001 to 2020 National Inpatient Sample (NIS). Pearson's χ2 tests were applied to categorical variables, and t-tests for continuous variables. We conducted a 1:1 propensity score matching (PSM). Multivariate regression models were deployed on the PSM sample to estimate the differences in several events and all-cause mortality.

Results

A total of 9,930,007 AMI patients were studied, of whom 117,641 (1.2%) reported cannabis use. Cannabis users had lower odds of atrial fibrillation (aOR = 0.902, p < 0.01), ventricular fibrillation (aOR = 0.919, p < 0.01), cardiogenic shock (aOR = 0.730, p < 0.01), acute ischaemic stroke (aOR = 0.825, p < 0.01), cardiac arrest (aOR = 0.936, p = 0.010), undergoing PCI (aOR = 0.826, p < 0.01), using IABP (aOR = 0.835, p < 0.01), and all-cause mortality (aOR = 0.640, p < 0.01), but with higher odds of supraventricular tachycardia (aOR = 1.104, p < 0.01), ventricular tachycardia (aOR = 1.054, p < 0.01), CABG use (aOR = 1.040, p = 0.010), and acute kidney injury (aOR = 1.103, p < 0.01).

Conclusions

Among patients aged 18-80 years admitted to hospital with AMI between 2001 and 2020 in the United States, cannabis use was associated with lower risks of cardiogenic shock, acute ischaemic stroke, cardiac arrest, PCI use, and in-hospital mortality.

In-hospital prognosis of acute ST-elevation myocardial infarction in patients with recent recreational drug use

AIMS

Although recreational drug use may induce ST-elevated myocardial infarction (STEMI), its prevalence in patients hospitalized in intensive cardiac care units (ICCUs), as well as its short-term cardiovascular consequences, remains unknown. We aimed to assess the in-hospital prognosis of STEMI in patients with recreational drug use from the ADDICT-ICCU study.

METHODS AND RESULTS

From 7-22 April 2021, recreational drug use was detected prospectively by a systematic urine multidrug test in all consecutive patients admitted for STEMI in 39 ICCUs across France. The primary endpoint was major adverse cardiac events (MACEs) defined by death, resuscitated cardiac arrest, or cardiogenic shock. Among the 325 patients (age 62 ± 13 years, 79% men), 41 (12.6%) had a positive multidrug test (cannabis: 11.1%, opioids: 4.6%, cocaine: 1.2%, 3,4-methylenedioxymethamphetamine: 0.6%). The prevalence increased to 34.0% in patients under 50 years of age. Recreational drug users were more frequently men (93% vs. 77%, p = 0.02), younger (50 ± 12 years vs. 63 ± 13 years, P < 0.001), and more active smokers (78% vs. 34%, P < 0.001). During hospitalization, 17 MACEs occurred (5.2%), including 6 deaths (1.8%), 10 cardiogenic shocks (3.1%), and 7 resuscitated cardiac arrests (2.2%). Major adverse cardiac events (17.1% vs. 3.5%, P < 0.001) and ventricular arrhythmia (9.8% vs. 1.4%, P = 0.01) were more frequent in recreational drug users. Use of recreational drugs was associated with more MACEs after adjustment for comorbidities (odds ratio = 13.1; 95% confidence interval: 3.4-54.6).

CONCLUSION

In patients with STEMI, recreational drug use is prevalent, especially in patients under 50 years of age, and is independently associated with an increase of MACEs with more ventricular arrhythmia.

TRIAL REGISTRATION

URL: https://clinicaltrials.gov/ct2/show/NCT05063097.

Global Insights into Chronic Obstructive Pulmonary Disease and Coronary Artery Disease: A Systematic Review and Meta-Analysis of 6,400,000 Patients

Background

The high prevalence of chronic obstructive pulmonary disease (COPD) in coronary artery disease (CAD) has been acknowledged over the past decade, although the cause/s remain uncertain due to differences in diagnoses. COPD has also become a leading CAD comorbidity, although again little is known about its interactions. This meta-analysis explored COPD prevalence in the global CAD population, as well as the influence of COPD on CAD.

Methods

PubMed, Web of Science, Embase, and grey literature were searched until 26th November 2021. The prevalence of COPD was calculated, and data were grouped according to COPD diagnostic methods, interventions, region, economic status, etc. Outcomes including all-cause death, cardiac death, myocardial infarction, revascularization, stroke, heart failure, and respiratory failure were analyzed. This study was registered with PROSPERO (CRD No.42021293270).

Results

There was an average prevalence of 14.2% for COPD in CAD patients (95% CI: 13.3-15.1), with diagnostics of COPD through spirometry, International Classification of the Diseases (ICD codes), and self-reported methods. Comorbid COPD-CAD patients were more likely to be smokers and suffer from cardiovascular and respiratory complications (all odds ratios [OR] > 1). COPD-CAD has higher mortality (hazard ratio [HR] 2.81, 95% CI: 2.40-3.29), and myocardial infarction, stroke, and respiratory failure rates (all HR > 1). Coronary artery bypass graft (CABG) reduces the need for revascularization (HR 0.43, 95% CI: 0.20-0.94) compared to percutaneous coronary intervention (PCI), without increasing mortality.

Conclusions

The global prevalence of COPD is particularly high in CAD patients. COPD-CAD patients are more likely to encounter cardiovascular and respiratory complications and endure poorer outcomes. Limited evidence suggests that CABG may reduce the need for revascularization without increasing mortality, although further research is required to confirm these observations.

Arrhythmic Effects of Cannabis in Ischemic Heart Disease

Rationale: Cannabis use is increasing worldwide, especially among older individuals at risk for chronic ischemic heart disease (IHD). However, little is known about the arrhythmic effects of cannabis use in IHD. Accordingly, we prospectively assessed the relationship between cannabis use, heart rate (HR), and arrhythmias in healthy age-matched controls and subjects with IHD. Methods: Healthy controls (n=37, 57% men) and subjects with IHD (myocardial infarction ≥3 months ago; n=24, 58% men) who used cannabis wore a Zio® (iRhythm Technologies) monitor for 14 days. Noncannabis using ischemic subjects (n=35, 51% males) wore Zio monitors for standard clinical indications. Baseline HR was compared with average HR measured for 4 h following consumption and changes in HR and frequency of arrhythmias were correlated with cannabis use. Results: In controls, HR increased 20 min (4.99±6.7 bpm, p=0.08) after use, then declined 4 h following use (-7.4±7.7, p<0.001). Conversely, subjects with IHD showed minimal HR increase (1.6±3.9 bpm) and blunted HR decline (-3.4±5.6 bpm, p<0.001). Supraventricular tachycardia (SVT) (29.7% vs. 58.3%; p=0.04) and nonsustained ventricular tachycardia (NSVT) (5.6% vs. 47.8%, p=0.01) were the most frequently occurring arrhythmias in controls and IHD subjects, respectively. Incidence of SVT decreased as cannabis use increased in both groups. Conversely, NSVT tended to increase with increased use in controls, and was significantly more prevalent in IHD. However, overall arrhythmia burden did not differ between cannabis users and nonusers with IHD. Conclusion: Our findings demonstrate that chronic cannabis use is associated with only mild HR changes, which are blunted in IHD. In addition, our data suggest that among cannabis users, arrhythmias are more frequent in IHD subjects that in healthy subjects.

Rising trend of acute myocardial infarction among young cannabis users: A 10-year nationwide gender and race stratified analysis

Background

The use of cannabis has massively increased among younger patients due to increasing legalization and availability.

Methods

We performed a retrospective nationwide study using the Nationwide inpatient sample (NIS) database to analyze the trends of acute myocardial infarction (AMI) in young cannabis users and related outcomes among patients aged 18-49 years from 2007 to 2018, using ICD-9 and ICD-10 codes.

Results

Out of 819,175 hospitalizations, 230,497 (28%) admissions reported using cannabis. There was a significantly higher number of males (78.08% vs. 71.58%, p < 0.0001) and African Americans (32.22% vs. 14.06%, p < 0.0001) admitted with AMI and reported cannabis use. The incidence of AMI among cannabis users consistently increased from 2.36% in 2007 to 6.55% in 2018. Similarly, the risk of AMI in cannabis users among all races increased, with the biggest increase in African Americans from 5.69% to 12.25%. In addition, the rate of AMI in cannabis users among both sexes showed an upward trend, from 2.63% to 7.17% in males and 1.62%-5.12% in females.

Conclusion

The incidence of AMI in young cannabis users has increased in recent years. The risk is higher among males and African Americans.

Impacts of medical and non-medical cannabis on the health of older adults: Findings from a scoping review of the literature

BACKGROUND

Cannabis legalization has enabled increased consumption in older adults. Age-related mental, physical, and physiological changes may lead to differences in effects of cannabis in older adults compared to younger individuals.

OBJECTIVE

To perform a scoping review to map the evidence regarding the health effects of cannabis use for medical and non-medical purposes in older adults.

METHODS

Electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Library) were searched for systematic reviews (SRs), randomized controlled trials (RCTs) and non-randomized/observational studies (NRSs) assessing the health effects and associations of cannabis use (medical or non-medical) in adults ≥ 50 years of age. Included studies met age-related inclusion criteria or involved a priori identified health conditions common among older adults. Records were screened using a liberal accelerated approach and data charting was performed independently by two reviewers. Descriptive summaries, structured tables, effect direction plots and bubble plots were used to synthesize study findings.

FINDINGS

From 31,393 citations, 133 publications describing 134 unique studies (26 SRs, 36 RCTs, 72 NRSs) were included. Medical cannabis had inconsistent therapeutic effects in specific patient conditions (e.g., end-stage cancer, dementia), with a number of studies suggesting possible benefits while others found no benefit. For medical cannabis, harmful associations outnumbered beneficial, and RCTs reported more negative effects than NRSs. Cannabis use was associated with greater frequencies of depression, anxiety, cognitive impairment, substance use and problematic substance use, accidents/injuries, and acute healthcare use. Studies often were small, did not consistently assess harms, and did not adjust for confounding.

DISCUSSION

The effects of medical cannabis are inconsistent within specific patient conditions. For older adults, generally, the available evidence suggests cannabis use may be associated with greater frequencies of mental health issues, substance use, and acute healthcare use, and the benefit-to-risk ratio is unclear. Studies with a balanced assessment of benefits and harms may guide appropriate public health messaging to balance the marketing pressures of cannabis to older adults.

Cannabinoid Poisoning-Related Emergency Department Visits and Inpatient Hospitalizations in Kentucky, 2017 to 2019

Background and objectives: Cannabis is the most used federally illicit substance. Due to widespread medicinal use and state-level legalization, public perceptions of cannabis have shifted toward the assumption that cannabis is safe. However, cannabinoids can cause adverse medical complications that may lead people to seek treatment. This study characterized cannabinoid poisoning-related medical encounters, poisoning involving cannabinoids and other psychoactive substances, and cannabinoid poisoning-related cardiac complications. Methods: Administrative billing data for emergency department visits and inpatient hospitalizations in acute care facilities with a discharge date from January 1, 2017 to December 31, 2019 were used to characterize cannabinoid poisoning events in Kentucky, identified by ICD-10-CM diagnosis code T40.7X. Results: There were 1,490 encounters of cannabinoid poisoning; patients were primarily non-Hispanic White males, ages 15-44, who had Medicaid and lived in a metropolitan area. Of those, 31.21% involved poisoning with a second psychoactive substance, primarily stimulants and/or opioids, and 17.72% experienced a cardiac complication. Cannabinoid-polydrug poisoning was associated with inpatient treatment (χ2=199.18, p < 0.001) and cardiac complications (χ2=4.58, p < 0.001). Discussion and Conclusions: These results are consistent with other state-level data. Patients who were diagnosed with cannabis-polydrug poisoning, compared to cannabis alone poisoning, had greater odds of hospital admission and cardiac complications, and longer length of hospital stays. Scientific Significance: The health risks of cannabinoid use must be more broadly recognized, while timely and accurate data need to be shared to guide policies on cannabis access. Future research on cannabinoid poisoning should consider the involvement of other psychoactive drugs.

[Acute coronary syndrome and cannabis use: a retrospective cohort study]

INTRODUCTION

Acute coronary syndrome (ACS) is the usual clinical entry point for coronary heart disease. France is the European country with the highest prevalence of cannabis use and an increase in serious cardiovascular complications, including infarction, related to cannabis. The main objective was to compare the clinical and cardiological profile of patients with ACS according to exposure to cannabis use.

POPULATION AND METHODS

We conducted a retrospective, single-centre, exposure-non-exposure cohort study of all adult patients (> 18 years) admitted for ACS in the ICU between January 1, 2012 and December 31, 2021 at the Centre Hospitalier de Troyes, with mention of cannabis use in the medical record. A matching was performed so that each patient identified in the exposed group was associated with a comparable unexposed patient on age, sex, period of hospitalisation and cardiovascular event typology (type of ACS and topography for ST+).

RESULTS

2745 patients admitted to the ICU and the coronary angiography room presented an ST+ or ST- ACS from 01/01/2012 to 31/12/2021 at the CHT. For 31 patients of them (1.1%), we noted cannabis consumption, which concern 7,9% of SCA ST+ aged under 50.

DISCUSSION

The link between cannabis use and ACS is established, but studies concerning the place of cannabis in the ACS pathway of an ICU are few in France. Our results show the interest of developing a specific pathway focused on the needs of patients and their specificities in post ACS management.

Cannabis, a Miracle Drug with Polyvalent Therapeutic Utility: Preclinical and Clinical-Based Evidence

Cannabis sativa L. is an annual herbaceous dioecious plant which was first cultivated by agricultural human societies in Asia. Over the period of time, various parts of the plant like leaf, flower, and seed were used for recreational as well as therapeutic purposes. The main chemical components of Cannabis sativa are termed as cannabinoids, among them the key psychoactive constituent is Δ-9-tetrahydrocannabinol and cannabidiol (CBD) as active nonpsychotic constituent. Upon doing extensive literature review, it was found that cannabis has been widely studied for a number of disorders. Very recently, a pure CBD formulation, named Epidiolex, got a green flag from both United States Food and Drug Administration and Drug Enforcement Administration for 2 rare types of epilepsies. This laid a milestone in medical cannabis research. This review intends to give a basic and extensive assessment, from past till present, of the ethnological, plant, chemical, pharmacological, and legal aspects of C. sativa. Further, this review contemplates the evidence the studies obtained of cannabis components on Alzheimer's, Parkinson's, amyotrophic lateral sclerosis, multiple sclerosis, emesis, epilepsy, chronic pain, and cancer as a cytotoxic agent as well as a palliative therapy. The assessment in this study was done by reviewing in extensive details from studies on historical importance, ethnopharmacological aspects, and legal grounds of C. sativa from extensive literature available on the scientific databases, with a vision for elevating further pharmaceutical research to investigate its total potential as a therapeutic agent.

Recent cannabis use and myocardial infarction in young adults: a cross-sectional study

BACKGROUND

Cannabis use is increasing among young adults, but its effects on cardiovascular health are poorly understood. We aimed to assess the association between recent cannabis use and history of myocardial infarction (MI) in young adults (aged 18-44 yr).

METHODS

We performed a cross-sectional study using pooled data from the 2017 and 2018 cohorts of the American Behavioral Risk Factor Surveillance System survey of US adults. We analyzed the association between any recent cannabis use and history of MI using a weighted logistic regression model that adjusted for demographic factors, socioeconomic factors, health-related behaviours, concomitant substance use and other comorbidities. We also assessed this association after stratifying by frequency of use and by primary method of consumption.

RESULTS

Among 33 173 young adults (18.5 million weighted), 4610 respondents (3.2 million weighted) reported recent cannabis use (17.5%, 95% confidence interval [CI] 16.8%-18.2%). A history of MI was more frequent among recent cannabis users (n = 61 of 4610, 1.3%) relative to nonusers (n = 240 of 28 563 [0.8%], adjusted odds ratio [OR] 2.07, 95% CI 1.12-3.82). A history of MI was associated with cannabis use of more than 4 times per month (adjusted OR 2.31, 95% CI 1.18-4.50), and with smoking as a primary method of consumption (adjusted OR 2.01, 95% CI 1.02-3.98).

INTERPRETATION

Our study provides evidence supporting an association between recent cannabis use and history of MI in young adults. Increasing cannabis use in an at-risk population could have negative implications for cardiovascular health.

Marijuana Use and In-Hospital Outcomes After Percutaneous Coronary Intervention in Michigan, United States

OBJECTIVES

The aim of this study was to evaluate the association between reported marijuana use and post-percutaneous coronary intervention (PCI) in-hospital outcomes.

BACKGROUND

Marijuana use is increasing as more states in the United States legalize its use for recreational and medicinal purposes. Little is known about the frequency of use and relative safety of marijuana among patients presenting for PCI.

METHODS

The authors analyzed Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry data between January 1, 2013, and September 30, 2016. One-to-one propensity matching and multivariable logistic regression were used to adjust for differences between patients with or without reported marijuana use, and rates of post-PCI complications were compared.

RESULTS

Among 113,477 patients, 3,970 reported marijuana use. Compared with those without reported marijuana use, patients with reported marijuana use were likely to be younger (53.9 years vs 65.8 years), to use tobacco (73.0% vs 26.8%), to present with ST-segment elevation myocardial infarction (27.3% vs 15.9%), and to have fewer cardiovascular comorbidities. After matching, compared with patients without reported marijuana use, those with reported marijuana use experienced significantly higher risks for bleeding (adjusted odds ratio [aOR]: 1.54; 95% confidence interval [CI]: 1.20-1.97; P < 0.001) and cerebrovascular accident (aOR: 11.01; 95% CI: 1.32-91.67; P = 0.026) and a lower risk for acute kidney injury (aOR: 0.61; 95% CI: 0.42-0.87; P = 0.007). There were no significant differences in risks for transfusion and death.

CONCLUSIONS

A modest fraction of patients undergoing PCI used marijuana. Reported marijuana use was associated with higher risks for cerebrovascular accident and bleeding and a lower risk for acute kidney injury after PCI. Clinicians and patients should be aware of the higher risk for post-PCI complications in these patients.

Pathophysiology and management of recreational drug-related acute coronary syndrome: ANMCO position statement

Recreational drug use may cause coronary artery disease through several mechanisms. An increasing number of young patients with drug-related acute coronary syndrome have been reported over recent years. The present position statement reports the most recent epidemiological data on acute coronary syndrome in the setting of drug abuse, describes the main pathophysiological mechanisms underlying coronary artery disease and acute events in these patients, and provides practical recommendations on management and an overview of prognosis.

A Literature Review of Cannabis and Myocardial Infarction-What Clinicians May Not Be Aware Of

Increasing legalization and expanding medicinal use have led to a significant rise in global cannabis consumption. With this development, we have seen a growing number of case reports describing adverse cardiovascular events, specifically, cannabis-induced myocardial infarction (MI). However, there are considerable knowledge gaps on this topic among health care providers. This review aims to provide an up-to-date review of the current literature, as well as practical recommendations for clinicians. We also focus on proposed mechanisms implicating cannabis as a risk factor for MI. We performed a comprehensive literature search using the MEDLINE, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Turning Research into Practice (TRIP) PRO databases for articles published between 2000 and 2018. A total of 92 articles were included. We found a significant number of reports describing cannabis-induced MI. This was especially prevalent among young healthy patients, presenting shortly after use. The most commonly proposed mechanisms included increased autonomic stimulation, altered platelet function, vasospasm, and direct toxic effects of smoke constituents. However, it is likely that the true pathogenesis is multifactorial. We should increase our pretest probability for MI in young patients presenting with chest pain. We also recommend against cannabis use in patients with known coronary artery disease, especially if they have stable angina. Finally, if patients are adamant about using cannabis, health care providers should recommend against smoking cannabis, avoidance of concomitant tobacco use, and use of the lowest delta-9-tetrahydrocannabinol dose possible. Data quality is limited to that of observational studies and case report data. Therefore, more clinical trials are needed to determine a definitive cause-and-effect relationship.

Role of Cannabis in the Incidence of Myocardial Infarction: A Review

Legalizing cannabis use in various states in the United States has caused increased substance abuse, mostly among young people. There are very little data focussing on marijuana use and myocardial infarction (MI) incidence. The objective of the study is to analyze the published papers for cannabis-induced MI and derive a strong relation between cannabis use and MI and understand the pathophysiology. An online search was conducted in PubMed, Google Scholar, and PubMed Central to find relevant publications examining patients who developed MI due to cannabis use. Out of 32 articles that were identified for this review, 17 are case reports, one is a letter to the editor, eight are observational studies, and six are review articles. Many studies have proposed different mechanisms by which cannabis affects the body. Our study shows that marijuana can precipitate MI even if it is used for the first time. Limited data is available to comment on the mortality of patients after cannabis-induced MI. These findings highlight the necessity for public awareness to prevent the ill-effects of cannabis, especially for teenagers and older people.

Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association

Cannabis, or marijuana, has potential therapeutic and medicinal properties related to multiple compounds, particularly Δ-9-tetrahydrocannabinol and cannabidiol. Over the past 25 years, attitudes toward cannabis have evolved rapidly, with expanding legalization of medical and recreational use at the state level in the United States and recreational use nationally in Canada and Uruguay. As a result, the consumption of cannabis products is increasing considerably, particularly among youth. Our understanding of the safety and efficacy of cannabis has been limited by decades of worldwide illegality and continues to be limited in the United States by the ongoing classification of cannabis as a Schedule 1 controlled substance. These shifts in cannabis use require clinicians to understand conflicting laws, health implications, and therapeutic possibilities. Cannabis may have therapeutic benefits, but few are cardiovascular in nature. Conversely, many of the concerning health implications of cannabis include cardiovascular diseases, although they may be mediated by mechanisms of delivery. This statement critically reviews the use of medicinal and recreational cannabis from a clinical but also a policy and public health perspective by evaluating its safety and efficacy profile, particularly in relationship to cardiovascular health.

Cannabis and acute myocardial infarction

Marijuana is one of the most commonly consumed psychotropic drugs in the world. It has been associated with adverse cardiovascular reactions including acute coronary syndrome, but this information is not widely known among emergency medicine clinicians. This article describes cannabis use as a contributing factor to acute myocardial infarction in a young woman with chest pain.

Acute neuroradiological, behavioral, and physiological effects of nose-only exposure to vaporized cannabis in C57BL/6 mice

Objective: The rapid increase of cannabis consumption reinforces the need to elucidate the health hazards of this practice. The presence of fine particulate matter in cannabis smoke and vapor poses a major concern, as it may contribute to cardiopulmonary disease. To facilitate the assessment of risks associated with cannabis inhalation, we developed and characterized a method for exposing mice to cannabis in a way that mimics the delivery of the drug to the airways of smokers. Materials and Methods: Cannabis (10.3% THC, 0.05% CBD) was vaporized to generate aerosols with a reproducible particle profile. Aerosols were acutely delivered to male, adult C57BL/6 mice via a nose-only exposure system. Serum THC levels were measured for increasing cannabis doses. Blood pressure and heart rate were recorded at baseline and following exposure. Behavioral response to cannabis inhalation in the open field was documented. Awake neurological activity upon cannabis exposure was monitored using BOLD fMRI.Results and Discussion: Cannabis aerosols contained particles with count median diameter of 243 ± 39 nm and geometric standard deviation of 1.56 ± 0.06. Blood serum THC levels increased linearly with aerosolized mass and peaked at 136 ± 5 ng/mL. Cannabis inhalation decreased heart rate and blood pressure but promoted anxiety-like behavior. Observed differences in BOLD activation volumes linked cannabis to increased awareness to sensory stimuli and reduced behavioral arousal.Conclusions: Quantified physiological, behavioral, and neurological responses served as validation for our mouse model of cannabis inhalation. Animal models of aerosol exposure will be instrumental for uncovering the health outcomes of chronic cannabis use.

Rates, predictors and the impact of cannabis misuse on in-hospital outcomes among patients undergoing percutaneous coronary intervention (from the National Inpatient Sample)

BACKGROUND

Whether cannabis use worsens outcomes in coronary heart disease is unknown and no previous study has evaluated the outcomes for patients who undergo percutaneous coronary intervention (PCI) according to cannabis use.

METHODS

We analysed patients in the National Inpatient Sample between 2004 and 2014 who underwent PCI and evaluated rates, predictors and outcomes of patients according to cannabis misuse defined by cannabis abuse or dependence.

RESULTS

A total of 7 306 012 patients were included and 32 765 cannabis misusers (0.4%). Cannabis misusers were younger (49.5 vs 64.6 years, P < .001) and were more likely to be male (82.7% vs 66.3%, P < .001). There was also a greater proportion of patients who were of black ethnicity in the cannabis misuse group (27.7% vs 7.9%, P < .001) and fewer elective admissions (7.8% vs 27.6%, P < .001). There was no difference in in-hospital mortality (OR 1.06 95% CI 0.80-1.40, P = .67), bleeding (OR 0.94 95% CI 0.77-1.15, P = .55) and stroke/transient ischaemic attack (OR 1.19 95% CI 0.98-1.45, P = .084) compared with non-cannabis misusers. Cannabis misusers had significantly lower odds of in-hospital vascular complications (OR 0.73 95% CI 0.58-0.90, P = .004).

CONCLUSIONS

Our results suggest that cannabis misusers are more likely to be male, of black ethnicity and from the lowest quartile of income, but there was no evidence that cannabis misuse is associated with worse periprocedural outcomes following PCI when controlling for key proxies of health status.

A commentary on the medicinal use of marijuana

Background

Lately, the number of people using marijuana in the USA has dramatically increased. In 2018, many states have legalized marijuana use for both medical and recreational purposes, thus exploring the evidence behind medical marijuana use became essential. Muslim majority countries enforce rigorous rules as marijuana has been a long-debated issue due to the stigma associated with its use as a treatment. Marijuana has a high beneficial effect in managing chronic pain in adults and relieving spasticity symptoms in multiple sclerosis, obstructive sleep apnea syndrome, and fibromyalgia. As well as, used as pain management, and as anti-emetic in treatment of chemotherapy-induced vomiting and nausea. Marijuana is requested from more than one-third of posttraumatic stress disorder patients due to its significant clinical improvement in nightmares and subsidence disorder symptoms.

Marijuana adversely affects the body’s resistance to many infections, compromising their immune response. Its recreational use has led to an increasing trend in the occurrence of major acute cardiovascular events as stroke, epilepsy, acute myocardial infarction, congestive heart failure, and arrhythmia.

Conclusion

Many countries started to allow medicinal use of marijuana due to its beneficial effect in managing chronic pain, spasticity symptoms in multiple sclerosis, obstructive sleep apnea syndrome, fibromyalgia, and posttraumatic stress disorder. But literature lacks benefit-harm analysis for marijuana usage in medicine. Therefore, evidence-based report of short- and long-term health effects of marijuana use—both harmful and beneficial effects—is crucial for further marijuana prescription in healthcare settings.

A Systematic Review of Marijuana Use and Outcomes in Patients with Myocardial Infarction

The prevalence of marijuana use is increasing after its legalization in a few states of the United States (US). Smoking marijuana is found to be associated with an increased risk of myocardial infarction (MI) immediately after its use. However, knowledge about the impact of marijuana on outcomes following MI is limited. In light of the rapidly shifting landscape regarding the legalization of marijuana for medical and recreational purposes, it is necessary to evaluate the impact of marijuana on the outcomes following MI. In this systematic review, we opted to review the effects of marijuana on in-hospital and long-term outcomes following MI.