Effects of Cannabinoids on Cardiovascular Disease
Cannabinoids have multiple adverse effects on the cardiovascular system, including stimulation of the sympathetic nervous system, platelet activation, endothelial dysfunction, and potential for arrhythmias and orthostatic hypotension, which can increase cardiovascular morbidity and mortality. 1
Cardiovascular Effects of Cannabinoids
Acute Cardiovascular Effects
- Cannabis use causes acute cardiovascular effects including tachycardia, orthostatic hypotension, and potential myocardial ischemia in at-risk individuals 2
- Cannabinoids can increase myocardial oxygen demand, which may precipitate ischemic events in susceptible individuals 1
- THC stimulates the sympathetic nervous system, leading to increased heart rate and blood pressure changes that can be detrimental in patients with existing cardiovascular disease 1
- Acute cannabis use has been associated with triggering myocardial infarction and cerebrovascular accidents in vulnerable populations 3
Long-term Cardiovascular Effects
- Long-term cannabis use is associated with adverse cardiovascular events, including myocardial infarction, stroke, and arrhythmias 2, 3
- Recreational substance use of cannabis was independently associated with premature cardiovascular disease in the Veterans Affairs Healthcare database 1
- Observational studies have found associations between marijuana and a broad range of adverse cardiovascular risks, with increasing potency of modern cannabis products potentially elevating these risks 4
Mechanisms of Cardiovascular Impact
Endocannabinoid System and Cardiovascular Function
- Cannabinoid receptors are widely distributed in cardiovascular tissues, including platelets, adipose tissue, and myocytes 4
- Activation of cannabinoid type 1 receptors (CB1Rs) generally leads to enhancement of atherosclerosis 5
- In contrast, cannabinoid type 2 receptors (CB2Rs) may have protective effects against atherosclerosis and ischemic injury, though clinical translation remains uncertain 5, 6
Pathophysiological Effects
- Cannabis causes platelet activation and aggregation, which may increase thrombotic risk 1, 2
- Endothelial dysfunction induced by cannabinoids can contribute to atherosclerosis progression 1, 7
- Smoking cannabis carries many of the same cardiovascular health hazards as smoking tobacco 4
Clinical Implications and Recommendations
Screening and Assessment
- Patients with chronic coronary disease (CCD) should be routinely asked and counseled about substance use, including cannabis, to reduce atherosclerotic cardiovascular disease (ASCVD) events 1
- Screening is especially important in young patients presenting with cardiovascular disease, as drug use was observed in 10% of patients <50 years of age presenting with myocardial infarction 1
Risk Mitigation
- Healthcare providers should be aware of potential drug-drug interactions between cannabinoids and cardiovascular medications 1
- Particular caution is warranted with high-risk medications like warfarin, buprenorphine, and tacrolimus, which have significant interaction potential with cannabinoids 1
- Patients using cannabis should be monitored for cardiovascular side effects including arrhythmias and orthostatic hypotension 1
Special Considerations
Synthetic Cannabinoids
- Synthetic cannabinoids may have more sustained and deleterious pharmacodynamic effects than natural cannabis 4
- These compounds have been linked to more severe cardiovascular complications 3, 4
Medical Cannabis
- Despite legalization in many states, medical marijuana has not been FDA-approved for cardiovascular indications 1
- Patients with CCD should not be advised to consume cannabis for the purpose of cardiovascular protection 1
Research Limitations
- Cannabis is classified as a Schedule I substance in the US, limiting rigorous study of its cardiovascular health effects 4
- Observational studies of the association between marijuana and cardiovascular events are limited by selection bias 1
- Long-term data about marijuana and cardiovascular risk are lacking, and most evidence comes from observational studies rather than randomized controlled trials 1, 4