Cannabis use has been reported to increase risk of ischemic stroke, the public, especially youth, about the cardiovascular risks associated with cannabis use .. and changes in spirometry even with relatively short duration of inhalation (87). In 28 states in this country, you can legally use marijuana for a range of health problems, including chronic pain, anxiety, and nausea. Smoking. Further research is needed to better understand the short-term and long-term effect of cannabis on heart disease and stroke. We encourage more research on .
Risks Cannabis in Summary and Heart
In a systematic review of case reports on stroke and cannabis use by Hackam 63 showed that current evidences point towards a temporal relationship between ischemic stroke and cannabis use. Cannabis related ischemic stroke has been found to have predilection for posterior circulation 64 which could be due to multifocal intracranial stenosis in vertebrobasilar territory Thanvi and Treadwell 59 listed the following as possible mechanisms underlying the occurrence of stroke after cannabis consumption: Recently, it was shown in rats that THC exposure induces cerebral mitochondrial dysfunction in dose dependent manner and increases reactive oxygen species production in the brain which could further contributes to its toxicity This apparent relationship of cannabis use and stroke notwithstanding, it should also be noted that stroke is not commonly reported in cannabis users While several reports have indicated the occurrence of ischemic stroke associated with cannabis use but occurrence of hemorrhagic stroke has been rarely reported.
They found that about half of the cannabis positive patients developed delayed cerebral ischemia vs. Cannabis use can also cause RCVS which is characterized by recurrent strong headaches and development of neurological focal deficit with reversible vasoconstriction on repeat intravascular imaging within three months It is possible that cannabis use is underdiagnosed or underreported in young adults developing ischemic and occasionally hemorrhagic stroke.
Therefore, the actual magnitude of the contribution of cannabis usage to the incidence of stroke among youth may be significantly underestimated. This highlights the need for proper and thorough history taking in such cases focusing on the history use of recent or chronic use of marijuana, especially in the absence of other risk factors for stroke.
A high degree of suspicion of illicit drug use, especially of cannabis, should be maintained in young patients presenting with stroke especially when no apparent cause of stroke can be found.
Rarely, development of stress cardiomyopathy has been temporally related to consumption of cannabis Recurrent stress cardiomyopathy involving cardiac apical and basal cardiac regions on two separate occasions in the same patient has also been reported. A case of recurrent myopericarditis was reported in a year-old male which occurred after heavy consumption of adulterated cannabis both times. Authors could not find any obvious causative factor other than use of cannabis Synthetic cannabinoids SCs are cannabis preparations that were synthesized during the process of identifying cannabinoid receptors.
JWH has stronger affinity for CB1 and CB2 receptors and produces extreme cannabinomimetic effects compared to marijuana. SCs are marketed under various other names including K2, skunk, joker, mojo, aroma, dream and black mamba etc.
The rising popularity of these products has been accompanied by a significant increase in the number of emergency admissions due to SCs. There is considerable risk of toxicity from either acute or chronic use with evidence of an increase in the number of chronic or even daily users of this class of drugs and a parallel increase in cases of withdrawal complications Although widely considered harmless, several recent reports have been published on cases of serious cardiovascular events attributed to the use of SCs.
The most prevalent cardiac side effect of SC consumption is tachycardia Chest pain has also been reported to occur after consumption of SCs Other reported cardiovascular events are peri-mesencephalic sub-arachnoid hemorrhage and middle cerebral artery occlusion Cases of ST-elevation MI, although rare, have been reported following the use of K2 in patients as young as 14 years old as well as in adults On the other hand, Orsini et al.
They hypothesized that consumption of K2 caused transient myocardial ischemia resulting in ventricular stunning leading to acute CHF Development of acute ischemic strokes due to consumption of SCs has also been reported in young adults without any history of predisposing factors This highlights importance of appropriate and complete history taking when patients in this age group present to the emergency department especially with cardiovascular events.
Important legal considerations relevant to the use of SCs are the lack of sufficiently reliable tests for their detection in urine, unlike those available for marijuana and the classification of these drugs as analogues of controlled substances rather than controlled substances Efforts to curb its use via the implementation of appropriate public health strategies are imperative.
Cannabis users may require surgery due to injuries or accidents occurring after recent use. Cannabis has been shown to cause significant respiratory symptoms and changes in spirometry even with relatively short duration of inhalation Cannabis use has been associated with significant airway inflammation and alteration in histopathology in bronchial mucosa and these effects appears to be additive when cannabis is smoked in conjunction with tobacco In one study, it was concluded that smoking of cannabis is associated with significant airway inflammation which was similar to what encountered in tobacco smokers Because of all these physiological and histopathological changes, patients undergoing surgery should be inquired about illicit drug use including cannabis 91 , The interactions between cannabis and anaesthetic agents and the effects of these interactions are poorly understood.
In a prospective, randomized, single blinded study, regular cannabis users showed variable response to induction of anaesthesia with propofol when compared to non-users, although higher doses of propofol were needed to achieve loss of consciousness, adequate jaw relaxation and depression of airway reflexes for insertion of laryngeal mask THC has also been reported to prolong the sedative effects of general anaesthesia in experimental models 94 , 95 , and has been implicated in perioperative complications such as bronchospasm due to airway irritation, tachycardia, and uvular oedema Cannabis leaves burn at higher temperature than similar quantity of tobacco causing increased direct airway irritation.
Excessive respiratory burden of carbon monoxide and tar can occur with cannabis smoking when compared to smoking Cannabis use is also possibly reported to be associated with diffuse alveolar haemorrhage in post-operative period in a patient which was thought to be due to 97 negative pressure pulmonary edema and possible inhibition of thrombin-driven clot formation It is important to extract history of cannabis use as a routine part of preoperative work up.
The choice of the appropriate anaesthetic agent is important in cases of cannabis users. If sedative hypnotic drugs are used in cannabis users, excessive depression of the central nervous system may occur; therefore, barbiturates, opioids, and benzodiazepines, and phenothiazines are preferably avoided. Further, recent use of cannabis can cause decrease blood pressure due to vasodilatation along with tachycardia leading to increased oxygen myocardial demand 99 , therefore drugs which are likely to increase HR, such as ketamine, atropine, and epinephrine should also be avoided It should also keep in mind that the intraoperative and immediate postoperative need of opiates for analgesia in patients with history of recent or chronic cannabis consumption may be significantly increased 92 , While the majority of published data suggest a harmful effect of cannabis and cannabinoids on the cardiovascular system, a few suggest possible beneficial effects.
The use of cannabis or marijuana has been linked to increase risk of cardiac events immediately after use, although little information is available about the long-term impact of marijuana among patients with established coronary disease.
An analysis carried out on around 4, MI patients from a U. Indirect beneficial effects have been demonstrated in studies showing that cannabis or marijuana use attenuates or modulates common cardiovascular disease risk factors.
Preliminary data from a small double blinded placebo controlled study carried out in the U. Additionally, a number of epidemiologic studies have shown lower prevalence of obesity and diabetes mellitus among marijuana users compared with those who never used marijuana, suggesting a relationship between cannabinoids and metabolic processes. A study done on adult Americans from the National Health and Nutrition Examination Survey showed that marijuana use was associated with lower levels of fasting insulin and HOMA-IR, and smaller waist circumference Furthermore, some studies hypothesized that lower rates of obesity among habitual marijuana users are directly related to the exposure to the THC present in cannabis, and proposed its potential use for the management of obesity and its complications A recently published study on mice that tested three regimens of THC administration suggests that a pre-treatment with an ultra-low dose of THC provides a significant protection against an ischemic insult to the heart as evidenced by lower troponin levels, and reduced infarct size The fact that cannabis use has become increasingly popular among youngsters is a major cause for concern.
It is important to consider a negative impact of cannabis abuse on education as well as the risk of abuse of other illicit drugs among the youth on the development of psychosis. Currently, there is a lack of consensus on what position to adopt regarding legalization of cannabis. While one view regards recreational cannabis uses as harmless, the opposing viewpoint is that it raises some serious public health concerns and that its use should continue to be discouraged by governing bodies and prohibited by law Table 2.
The literature suggests the occurrence of harmful effects including fatal cardiovascular events that could be related to cannabis use. Further research and studies are needed to determine the impact of acute and especially the chronic regular use of cannabis on various organ systems, particularly the cardiovascular system. With the recent decriminalization and legalisation of cannabis use in some parts of the world and the increase in the number of conditions that cannabis can be prescribed for, there is a good possibility that physicians will encounter more cases of cardiovascular and cerebrovascular complications of cannabis use in the near future.
It is necessary to increase awareness among physicians and the general public alike regarding the increased risk of cardiovascular complications associated with cannabis use. In addition, implementing effective strategies for the prudent dispersal of the drug is necessary to avoid unnecessary increases in cannabis-related complications and therefore preclude the resultant burden on public and private health services.
The current evidences highlight the urgent need for a change in the mindset among cannabis users, particularly the young regarding the adverse effects of cannabis use and the risk of acute coronary events, stroke, and possibly death.
Authors would like to acknowledge Dr. Amar Shere MD for creating the online versions of all figures. The authors have no conflicts of interest to declare. National Center for Biotechnology Information , U. Journal List J Thorac Dis v. Hemant Goyal , 1 Hamza H. Awad , 2 and Jalal K. Author information Article notes Copyright and License information Disclaimer. I Conception and design: All authors; V Data analysis and interpretation: All authors; VI Manuscript writing: All authors; VII Final approval of manuscript: Received Apr 9; Accepted Jun Copyright Journal of Thoracic Disease.
This article has been cited by other articles in PMC. Abstract The growing popularity of medical and recreational consumption of cannabis, especially among the youth, raises immediate concerns regarding its safety and long-terms effects. Cannabis, marijuana, cardiovascular, myocardial infarction MI , atrial fibrillation, stroke, synthetic marijuana. Introduction Currently, cannabis is the most widely produced and consumed illicit drug in the world with global numbers of users approaching Cannabis and acute coronary syndrome In the past, risk of ischemia associated with marijuana use was considered to be low Table 1 Proposed pathophysiology of cannabis-induced acute myocardial infarction Depending on cardiac catheterization findings.
Angiogram finding Possible mechanisms Normal angiogram Reversible coronary vasospasm Increased carboxyhemoglobin blood levels Increase in sympathetic activity Coronary artery dissection Hemodynamic effects Coronary thrombosis Down-stream plaque rupture, direct pro-thrombotic effect Sluggish coronary flow Pro-thrombotic effect Coronary artery stenosis Angiopathy, plaque rupture.
Open in a separate window. Proposed mechanisms for cannabis induced cardiovascular effects. Peripheral vascular effects of cannabis The effects of cannabis on peripheral vasculature have not been clinically well studied yet. Effects on cerebrovascular system Currently, the evidence regarding the relationship between stroke and cannabis use is not firmly established, although a temporal link has been reported in several cases of ischemic stroke with no other apparent causes Proposed mechanisms of cannabis induced cerebrovascular effects.
Other reported adverse cardiac effects of cannabis use Takotsubo cardiomyopathy Rarely, development of stress cardiomyopathy has been temporally related to consumption of cannabis Myopericarditis A case of recurrent myopericarditis was reported in a year-old male which occurred after heavy consumption of adulterated cannabis both times. Synthetic marijuana and its cardiovascular complications Synthetic cannabinoids SCs are cannabis preparations that were synthesized during the process of identifying cannabinoid receptors.
Pre- and perioperative implications of cannabis use Cannabis users may require surgery due to injuries or accidents occurring after recent use. Potential beneficial effects of cannabis in cardiovascular system While the majority of published data suggest a harmful effect of cannabis and cannabinoids on the cardiovascular system, a few suggest possible beneficial effects.
Conclusions The fact that cannabis use has become increasingly popular among youngsters is a major cause for concern.
Table 2 The effects of cannabis on the cardiovascular system. Acknowledgements Authors would like to acknowledge Dr. Footnotes Conflicts of Interest: World Drug Report Racial differences and the role of neighborhood in the sequencing of marijuana and tobacco initiation among urban youth.
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ST-segment elevation myocardial infarction in a year-old man with normal coronaries--it is not always cocaine!
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Cannabis use and blood pressure levels: J Hypertens ; Triphasic blood pressure responses to cannabinoids: Acute and long-term effects of cannabis use: Curr Pharm Des ; J Addict Med ; 4: J Eur Acad Dermatol Venereol ; Images in vascular medicine. It is not clear, though, if cannabis use causes the problems or if the causality is in the reverse.
Recent studies have shown that IQ deficits existed in subjects before chronic cannabis use, suggesting that lower IQ may instead be a risk factor for cannabis addiction. Dependence on cannabis tends to be less severe than that observed with cocaine, opiates, and alcohol.
Historically, the possible connection between psychosis and cannabis has been seen as controversial. Cannabis can contain over different cannabinoid compounds , many of which have displayed psychoactive effects.
As of there is clear evidence that long term use of cannabis increases the risk of psychosis, regardless of confounding factors, and particularly for people who have genetic risk factors. Numerous studies have been conducted regarding anxiety and cannabis for therapeutic purposes, and these cross-sectional studies have been mostly consistent regarding the anxiolytic effects.
The studies showed relief of anxiety as a result of cannabis consumption. According to one review, long term cannabis use "increases the risk of psychosis in people with certain genetic or environmental vulnerabilities", but does not cause psychosis. Important predisposing factors include genetic liability, childhood trauma and urban upbringing.
Key predisposing variables include age of first exposure, frequency of use, the potency of the cannabis used, and individual susceptibility. The authors found that cannabis use alone does not predict the transition to subsequent psychiatric illness. Many factors are involved, including genetics, environment, time period of initiation and duration of cannabis use, underlying psychiatric pathology that preceded drug use, and combined use of other psychoactive drugs.
A review said that "[b]ecause longitudinal work indicates that cannabis use precedes psychotic symptoms, it seems reasonable to assume a causal relationship" between cannabis and psychosis, but that "more work is needed to address the possibility of gene-environment correlation. A meta-analysis found that cannabis use increases the risk of psychosis, and that a dose-response relationship exists between the level of cannabis use and risk of psychosis.
The analysis was not able to establish a causal link. A review found that the epidemiologic evidence regarding cannabis use and psychosis was strong enough "to warrant a public health message that cannabis use can increase the risk of psychotic disorders," but also cautioned that additional studies are needed to determine the size of the effect.
There is substantial evidence of a statistical association between cannabis use and the development of schizophrenia or other psychoses, with the highest risk among the most frequent users.
Use of cannabis in adolescence or earlier is correlated with developing schizoaffective disorders in adult life, although the proportion of these cases is small. Susceptibility is most often found in users with at least one copy of the polymorphic COMT gene. CBD may show antipsychotic and neuroprotective properties, acting as an antagonist to some of the effects of THC.
Studies examining this effect have used high ratios of CBD to THC, and it is unclear to what extent these laboratory studies translate to the types of cannabis used by real life users.
Teenage cannabis users show no difference from the general population in incidence of major depressive disorder MDD , but an association exists between early exposure coupled with continued use into adult life and increased incidence of MDD in adulthood. Among those who have been previously diagnosed with bipolar disorder , cannabis may worsen the occurrence of manic symptoms. Adolescent cannabis users show no difference from their peers in suicidal ideation or rate of suicide attempts, but those who continue to use cannabis into adult life exhibit an increased incidence of both, although multiple other contributory factors are also implicated.
In the general population a weak indirect association appears to exist between suicidal behaviour and cannabis consumption in both psychotic and non-psychotic users,  although it remains unclear whether regular cannabis use increases the risk of suicide. The gateway drug hypothesis asserts that the use of soft drugs such as cannabis, tobacco or alcohol may ultimately lead to the use of harder drugs. Whether the role of cannabis in other drug use is causative or simply the result of the same influencing factors of drug use in general is debated.
Large-scale longitudinal studies in the UK and New Zealand from and showed an association between cannabis use and an increased probability of later disorders in the use of other drugs. A literature review said that exposure to cannabis was "associated with diseases of the liver particularly with co-existing hepatitis C , lungs, heart, and vasculature".
The authors cautioned that "evidence is needed, and further research should be considered, to prove causal associations of marijuana with many physical health conditions". Imaging studies suggest that long-term exposure does not lead to decreases in white matter or grey matter volume, but may lead to reductions in hippocampal volume. Variations in the methodologies used lend some uncertainty to this conclusion.
The acute effects of cannabis use in humans include a dose-dependent increase in heart rate, typically accompanied by a mild increase in blood pressure while lying down and postural hypotension - a drop in blood pressure when standing up. These effects may vary depending on the relative concentration of the many different cannabinoids that can affect the cardiovascular function, such as cannabigerol. Smoking cannabis decreases exercise tolerance. Cannabis use by people with cardiovascular disease poses a health risk because it can lead to increased cardiac work, increased catecholamine levels, and impaired blood oxygen carrying capacity due to the production of carboxyhemoglobin.
A review examining the relation of cancer and cannabis found little direct evidence that cannabinoids found in cannabis, including THC , are carcinogenic. Cannabinoids are not mutagenic according to the Ames test. However, cannabis smoke has been found to be carcinogenic in rodents and mutagenic in the Ames test. Correlating cannabis use with the development of human cancers has been problematic due to difficulties in quantifying cannabis use, unmeasured confounders , and that cannabinoids may have anti-cancer effects.
According to a literature review, cannabis could be carcinogenic, but there are methodological limitations in studies making it difficult to establish a link between cannabis use and cancer risk. According to Gordon and colleagues, "several recent studies suggest an association between marijuana use and testicular germ cell tumors". There have been a limited number of studies that have looked at the effects of smoking cannabis on the respiratory system.
Regular cannabis smokers show pathological changes in lung cells similar to those that precede the development of lung cancer in tobacco smokers. A review which specifically examined the effects of cannabis on the lung concluded "[f]indings from a limited number of well-designed epidemiological studies do not suggest an increased risk for the development of either lung or upper airway cancer from light or moderate use, although evidence is mixed concerning possible carcinogenic risks of heavy, long-term use.
In the International Lung Cancer Consortium found no significant additional lung cancer risk in tobacco users who also smoked cannabis.
Nor did they find an increased risk in cannabis smokers who did not use tobacco. They concluded that "[o]ur pooled results showed no significant association between the intensity, duration, or cumulative consumption of cannabis smoke and the risk of lung cancer overall or in never smokers. Cannabis smoke contains thousands of organic and inorganic chemicals, including many of the same carcinogens as tobacco smoke.
They said there was an increased risk from each cannabis cigarette due to drawing in large puffs of smoke and holding them. A review of studies in the United States found that although some supported the hypothesis that cannabis use increased the risk of getting head and neck cancer, when other factors are accounted for the majority did not. A literature review by Gordon and colleagues concluded that inhaled cannabis is associated with lung disease,  although Tashkin's review has found "no clear link to chronic obstructive pulmonary disease ".
Of the various methods of cannabis consumption, smoking is considered the most harmful; the inhalation of smoke from organic materials can cause various health problems e. Isoprenes help to modulate and slow down reaction rates, contributing to the significantly differing qualities of partial combustion products from various sources.
Smoking cannabis has been linked to adverse respiratory effects including: In a few case reports involving immunocompromised patients, pulmonary infections such as aspergillosis have been attributed to smoking cannabis contaminated with fungi. The transmission of tuberculosis has been linked to cannabis inhalation techniques, such as sharing water pipes and ' Hotboxing '.
A study released by the National Academies of Sciences, Engineering, and Medicine cited significant evidence for a statistical link between mothers who smoke cannabis during pregnancy and lower birth weights of their babies. No fatal overdoses associated with cannabis use have been reported. Motor vehicle accidents, suicide, and possible respiratory and brain cancers are all of interest to many researchers, but no studies have been able to show a consistent increase in mortality from these causes.
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Addict Sci Clin Pract Review. Drug and Alcohol Dependence. A guided systematic review". Asian J Psychiatr Review. Dtsch Arztebl Int Review. Revista Brasileira de Psiquiatria.
Marijuana and heart health: What you need to know
With it came a fairly shocking conclusion, “marijuana use may increase the risk for hypertension mortality”, a statement that is bound to cause. A new study from Boston's Beth Israel Deaconess Medical Center and Harvard Medical School says marijuana increases the risk of having a heart attack within . Marijuana has both short-and long-term effects on the brain. . Marijuana use has also been linked to other mental health problems, such as depression, anxiety.