Cannabis by any name does not smell as sweet: potential cardiovascular events with medical cannabis

Recently, attitudes towards cannabis and its use have changed dramatically and continue to evolve worldwide. In 2014, many states in the USA started legalizing cannabis, thus increasing the availability of medical and recreational cannabis and creating an entire cannabis industry with dispensaries on many street corners.1 Within most of the European Union (EU), cannabis remains illegal; however, recently many countries have begun to legalize cannabis for limited therapeutic purposes. Countries such as Germany, the Czech Republic, Denmark, Germany, Italy, and Poland now permit the cultivation of cannabis for medical purposes, with the cultivation and subsequent processing taking place under the usually strict rules applicable to agricultural, manufacturing, distribution, security, and clinical good practice.2 Close pharmacovigilance of cannabis, as well as its safety and efficacy, have been limited by decades of worldwide illegality and by the ongoing classification of cannabis as a Schedule 1 controlled substance in the USA. Nonetheless, with increased cannabis decriminalization and legalization across the globe, the association between cannabis exposure and incident cardiovascular (CV) events has emerged as an important safety signal.

Cannabidiol represses miR-143 to promote cardiomyocyte proliferation and heart regeneration after myocardial infarction

Mammalian heart is capable to regenerate almost completely early after birth through endogenous cardiomyocyte proliferation. However, this regenerative capacity diminishes gradually with growth and is nearly lost in adulthood. Cannabidiol (CBD) is a major component of cannabis and has various biological activities to regulate oxidative stress, fibrosis, inflammation, and cell death. The present study was conducted to investigate the pharmacological effects of CBD on heart regeneration in post-MI mice.

Associations Between Monthly Cannabis Use and Myocardial Infarction in Middle-Aged Adults: NHANES 2009 to 2018

Mechanistic research suggests using Cannabis sativa L. (cannabis or marijuana) may increase the risk of cardiometabolic disease, but observational studies investigating associations between cannabis use and myocardial infarction (MI) have reported inconsistent results. Cross-sectional National Health and Nutrition Examination Survey data from five 2-year cycles between 2009 and 2018 and representing 9,769 middle-aged adults (35 to 59 years old) were analyzed. Multivariable logistic regression models accounting for sampling weights and adjusting for cardiovascular risk factors were used to assess associations between a history of monthly cannabis use before MI and a subsequent MI. A quarter of respondents (n = 2,220) reported a history of monthly use >1 year before an MI. A history of MI was reported by 2.1% of all respondents and 3.2.% of those who reported a history of monthly use. In fully adjusted multivariable models, and compared with never use, a history of monthly cannabis use preceding an MI was not associated with an MI (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.35 to 1.71). However, when stratified by recent use, the odds of MI were threefold greater (OR 2.98, 95% CI 1.08 to 8.60) when no use was reported within the past month than when use was reported within the past month. Duration of monthly use was also not significantly associated with MI, including monthly use >10 years (OR 0.78, 95% CI 0.30 to 2.01). In conclusion, in a representative sample of middle-aged US adults, a history of monthly cannabis use >1 year before an MI was not associated with a subsequent physician-diagnosed MI, except for threefold greater odds when cannabis was not used within the past month.

Effects of CBD supplementation on ambulatory blood pressure and serum urotensin-II concentrations in Caucasian patients with essential hypertension: A sub-analysis of the HYPER-H21-4 trial

HYPER-H21–4 was a randomized crossover trial that aimed to determine if cannabidiol (CBD), a non-intoxicating constituent of cannabis, has relevant effects on blood pressure and vascular health in patients with essential hypertension. In the present sub-analysis, we aimed to elucidate whether serum urotensin-II concentrations may reflect hemodynamic changes caused by oral supplementation with CBD. The sub-analysis of this randomized crossover study included 51 patients with mild to moderate hypertension that received CBD for five weeks, and placebo for five weeks. After five weeks of oral CBD supplementation, but not placebo, serum urotensin concentrations reduced significantly in comparison to baseline (3.31 ± 1.46 ng/mL vs. 2.08 ± 0.91 ng/mL, P < 0.001). Following the five weeks of CBD supplementation, the magnitude of reduction in 24 h mean arterial pressure (MAP) positively correlated with the extent of change in serum urotensin levels (r = 0.412, P = 0.003); this association was independent of age, sex, BMI and previous antihypertensive treatment (β ± standard error, 0.023 ± 0.009, P = 0.009). No correlation was present in the placebo condition (r = −0.132, P = 0.357). In summary, potent vasoconstrictor urotensin seems to be implicated in CBD-mediated reduction in blood pressure, although further research is needed to confirm these notions.

Application of medical cannabis in unstable angina and coronary artery disease

First discovered in 1990, the endocannabinoid system (ECS) was initially shown to have an intimate relationship with central areas of the nervous system associated with pain, reward, and motivation. Recently, however, the ECS has been extensively implicated in the cardiovascular system with contractility, heart rate, blood pressure, and vasodilation. Emerging data demonstrate modulation of the ECS plays an essential role in cardio metabolic risk, atherosclerosis, and can even limit damage to cardiomyocytes during ischemic events.

Therapeutic Applications of Cannabinoids in Cardiomyopathy and Heart Failure

Authors: J. A. Garza-Cervantes, M. Ramos-González ,O. Lozano, C. Jerjes-Sánchez , and G. García-Rivas Published in Oxidative Medicine and Cellular Longevity October 2020 Abstract A large number of cannabinoids have…

Cannabis use predicts risks of heart failure and cerebrovascular accidents: results from the National Inpatient Sample.

Authors: Aditi Kalla, Parasuram Krishnamoorthy, Akshaya Gopalakrishnan, Vincent Figueredo
Journal of Cardiovascular Medicine, September 2018

BACKGROUND: Cannabis for medicinal and/or recreational purposes has been decriminalized in 28 states as of the 2016 election. In the remaining states, cannabis remains the most commonly used illicit drug. Cardiovascular effects of cannabis use are not well established due to a…

Cannabinoids, the Heart of the Matter.

Authors: Naghum Alfulaij, Franziska Meiners, Justin Michalek, Andrea L. Small‐Howard, et al
Journal of the American Heart Association, 13 July 2018

Cardiovascular disease (CVD) is a global epidemic representing the leading cause of death in some Western countries. According to the American Heart Association, a total of 92.1 million US citizens currently have ≥1 forms of CVD, with numbers expected to grow reaching up to 4…

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

Authors: Cecelia P. Johnson-Sasso, Christine Tompkins, David P. Kao, Lori A. Walker
PLoS One, 11 July 2018

Marijuana use is increasing worldwide, and it is ever more likely that patients presenting with acute myocardial infarctions (AMI) will be marijuana users. However, little is known about the impact of marijuana use on short-term outcomes following AMI. Accordingly, we compared…

Cannabis and Heart Disease: Forward Into the Great Unknown?

Authors: Joshua D. Lee, Daniel Schatz, Judith Hochman
Journal of the American College of Cardiology, 5 June 2018

The paper by DeFilippis et al. (1) in this issue of the Journal is a timely reminder of how little we know about cannabis consumption, cardiovascular disease (CVD), and cannabis’ health effects in general. It is also a firm confirmation of the negative effects of any cocaine u…

Cocaine and Marijuana Use Among Young Adults With Myocardial Infarction.

Authors: Ersilia M. DeFilippis, Avinainder Singh, Sanjay Divakaran, Ankur Gupta, Bradley L. Collins, et al
Journal of the American College of Cardiology, 5 June 2018

BACKGROUND: Substance abuse is increasingly prevalent among young adults, but data on cardiovascular outcomes remain limited. OBJECTIVES: The objectives of this study were to assess the prevalence of cocaine and marijuana use in adults with their first myocardial infarction (M…

Associations Between Marijuana Use and Cardiovascular Risk Factors and Outcomes: A Systematic Review.

Authors: Divya Ravi, Mehrnaz Ghasemiesfe, Deborah Korenstein, Thomas Cascino, Salomeh Keyhani
Annals of Internal Medicine, 6 February 2018

BACKGROUND: Marijuana use is increasing in the United States, and its effect on cardiovascular health is unknown. PURPOSE: To review harms and benefits of marijuana use in relation to cardiovascular risk factors and clinical outcomes. DATA SOURCES: PubMed, MEDLINE, EMBASE, Psy…