Cardiovascular Complications of Marijuana and Related Substances: A Review
Open Access
- 7 December 2017
- journal article
- review article
- Published by Springer Science and Business Media LLC in Cardiology and Therapy
- Vol. 7 (1), 45-59
- https://doi.org/10.1007/s40119-017-0102-x
Abstract
The recreational use of cannabis has sharply increased in recent years in parallel with its legalization and decriminalization in several countries. Commonly, the traditional cannabis has been replaced by potent synthetic cannabinoids and cannabimimetics in various forms. Despite overwhelming public perception of the safety of these substances, an increasing number of serious cardiovascular adverse events have been reported in temporal relation to recreational cannabis use. These have included sudden cardiac death, vascular (coronary, cerebral and peripheral) events, arrhythmias and stress cardiomyopathy among others. Many of the victims of these events are relatively young men with few if any cardiovascular risk factors. However, there are reasons to believe that older individuals and those with risk factors for or established cardiovascular disease are at even higher danger of such events following exposure to cannabis. The pathophysiological basis of these events is not fully understood and likely encompasses a complex interaction between the active ingredients (particularly the major cannabinoid, Δ9-tetrahydrocannabinol), and the endo-cannabinoid system, autonomic nervous system, as well as other receptor and non-receptor mediated pathways. Other complicating factors include opposing physiologic effects of other cannabinoids (predominantly cannabidiol), presence of regulatory proteins that act as metabolizing enzymes, binding molecules, or ligands, as well as functional polymorphisms of target receptors. Tolerance to the effects of cannabis may also develop on repeated exposures at least in part due to receptor downregulation or desensitization. Moreover, effects of cannabis may be enhanced or altered by concomitant use of other illicit drugs or medications used for treatment of established cardiovascular diseases. Regardless of these considerations, it is expected that the current cannabis epidemic would add significantly to the universal burden of cardiovascular diseases.Keywords
This publication has 130 references indexed in Scilit:
- Acute Myocardial Infarction in a Young Man; Fatal Blow of the Marijuana: A Case ReportKorean Circulation Journal, 2012
- Myocardial Infarction Associated With Use of the Synthetic Cannabinoid K2PEDIATRICS, 2011
- Cannabis‐related hospitalizations: unexpected serious events identified through hospital databasesBritish Journal of Clinical Pharmacology, 2011
- Ventricular fibrillation triggered by marijuana use in a patient with ischemic cardiomyopathy: a case reportCases Journal, 2008
- Modulation of the Endocannabinoid System in Cardiovascular DiseaseHypertension, 2008
- Cannabis arteritisJournal of the American Academy of Dermatology, 2008
- An exploratory prospective study of marijuana use and mortality following acute myocardial infarctionAmerican Heart Journal, 2008
- Pharmacological Inhibition of CB1Cannabinoid Receptor Protects Against Doxorubicin-Induced CardiotoxicityJournal of the American College of Cardiology, 2007
- Single and multiple doses of rimonabant antagonize acute effects of smoked cannabis in male cannabis usersPsychopharmacology, 2007
- Coronary no-flow and ventricular tachycardia associated with habitual marijuana useAnnals of Emergency Medicine, 2003