Marijuana Use May Raise the Risk of Serious Heart Conditions
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At a time when legal access to marijuana is becoming more common, two new studies presented at the annual scientific meeting of the American Heart Association suggest that this drug may negatively impact heart health.
One study of more than 150,000 adults found an association between daily marijuana use and a 34 percent higher risk of heart failure, in part because of higher likelihood of coronary artery disease. Another study, of more than 10 million older adults, linked marijuana use to a 20 percent higher risk of events like heart attacks and strokes during hospital stays.
“When I interact with patients, they always tell me, ‘Well, it’s natural, so it must be safe.’ Well, that’s very far from the truth,” says Robert Page II, PharmD, a professor at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado in Aurora and the lead author of an AHA scientific statement on marijuana use released in 2020.
Marijuana Affects Blood Pressure and Heart Disease Risk
The reality is that people need to think of marijuana as a risk factor for cardiovascular disease events like heart failure, heart attacks, and strokes, says Dr. Page, who wasn’t involved in either of the new studies.
Marijuana use, whether it’s vaped or smoked, can lead to a drop in blood pressure that increases the risk of stroke, Page says. And with long-term daily use, marijuana can also lead to an increase in blood pressure over time that raises the risk of other types of cardiovascular issues.
In the study of daily marijuana use, the participants were either recreational users or medical users who took more of the drug than their doctors prescribed. The drug might increase the risk of events like heart failure because marijuana acts on so-called cannabinoid receptors in muscles in the heart and in the blood vessels of the heart and brain, says the study’s lead author, Yakubu Bene-Alhasan, MD, MPH, a resident physician in internal medicine at Medstar Health Baltimore and a research fellow at Beth Israel Deaconess Medical Center in Boston.
“Activation of these receptors leads to varying effects which could be detrimental,” Dr. Bene-Alhasan says.
For instance, in the heart muscle, marijuana reduces the ability of the heart to contract properly, which can lead to heart failure, Bene-Alhasan says. Marijuana also causes the blood vessels in the heart to narrow and could lead to clot formation in these vessels. “Both of these could lead to heart attacks,” Bene-Alhasan adds.
Marijuana Use in Adults Over 65 Has Doubled Since 2015
One limitation of this study, however, is that researchers lacked data to determine whether the effects of marijuana on the cardiovascular system might differ based on how the drug is consumed. More research is needed to explore, for example, whether vaped, smoked, and edible marijuana products might have different effects on the heart and brain, Bene-Ahasan says.
In the second study focused on marijuana users over 65 years old, all the participants had preexisting heart disease risk factors such as high blood pressure, elevated cholesterol, or type 2 diabetes. None, however, were cigarette smokers, another main risk factor for cardiovascular disease events like heart attacks and strokes. About 29,000 of them had a diagnosis of cannabis use disorder.
Understanding the risks of marijuana use among older adults is crucial, because cannabis use in this population has more than doubled since 2015, said the lead study author, Avilash Mondal, MD, a resident physician at Nazareth Hospital in Philadelphia, in a statement.
“We must be mindful about major heart and stroke events in older adults with cannabis use disorder,” Dr. Mondal said.
While more research is still needed, Mondal added that doctors should be asking about cannabis use during regular checkups. “If you ask patients if they are smoking, people think [of] cigarette smoking,” Mondal said. “The main public message is to be more aware of the increased risks and open the lines of communication so that cannabis use is acknowledged and considered.”
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