Abstract
Purpose of Review
The purpose of the study was to examine the published evidence on the cardiovascular risk related to the use of cannabis-based products by performing a systematic review of recent literature.
Recent Findings
The World Health Organization (WHO) emphasizes that cannabis use represents a risky behavior as it may lead to many adverse effects, and in particular, cardiovascular effects.
Summary
A systematic review of articles published between January 1, 2011 and May 31, 2016 was performed in agreement with the PRISMA statement. Articles presenting data on humans exposed to cannabis-based products and suffering from any cardiovascular condition were eligible for inclusion. The inclusion process was based on a search algorithm and performed in a blinded standardized manner. Overall, 826 articles were found in the literature search, 115 of which remained after performing the inclusion procedure. These were 81 case reports, 29 observational studies, 3 clinical trials, and 2 experimental studies. A total of 116 individuals was the subject of case reports. The mean age was 31 years (95%CI = 29–34), and patients were more frequently men (81.9%) than women (18.1%). They mainly suffered from ischemic strokes or myocardial infarctions. Data provided by the 29 included observational studies evidenced an association between exposure to cannabis-based products and cardiovascular disease. Currently, this evidence is stronger for ischemic strokes than for any other cardiovascular diseases. While the data are limited, there is some suggestion that cannabis use may have negative cardiovascular consequences, particularly at large doses.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance•• Of major importance
United Nations Office on Drugs and Crime (UNODC). World drug report 2016 [Internet]. New York: United Nations publication; 2016 [Accessed 26 August 2016] p. 174. Available from: http://www.unodc.org/doc/wdr2016/WORLD_DRUG_REPORT_2016_web.pdf
Montecucco F, Di Marzo V. At the heart of the matter: the endocannabinoid system in cardiovascular function and dysfunction. Trends Pharmacol Sci. 2012;33(6):331–40.
World Health Organization. WHO | The health and social effects of nonmedical cannabis use [Internet]. Geneva, Switzerland; 2016 [Accessed 26 August 2016] p. 62. Available from: http://www.who.int/substance_abuse/publications/cannabis_report/en/
•• Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103:2805–9. This study remains the sentinel study published in the domain of cannabis-related cardiovascular complications. Moreover, it is one of the very few focused on myocardial infarctions (rather than strokes).
Jouanjus E, Lapeyre-Mestre M, Micallef J. Cannabis use: signal of increasing risk of serious cardiovascular disorders. J Am Heart Assoc. 2014;3(2):e000638.
Canga Y, Osmonov D, Karatas MB, Durmus G, Ilhan E, Kirbas V. Cannabis: a rare trigger of premature myocardial infarction. Anadolu Kardiyol Derg- Anatol J Cardiol mai. 2011;11(3):272–4.
De Silva K, Perera D. Cannabis, collaterals, and coronary occlusion. Case Rep Cardiol. 2011;2011:e469850.
Kaushik M, Alla VM, Madan R, Arouni AJ, Mohiuddin SM. Recurrent stress cardiomyopathy with variable regional involvement insights into etiopathogenetic mechanisms. Circulation. 2011;124(22):E556–E557.
Maguire M, Seidi O, Baker M, Gupta A, Muwanga C. Acute mutism: a useful lesson. Emerg Med J EMJ. 2011;28(1):82–3.
Mir A, Obafemi A, Young A, Kane C. Myocardial infarction associated with use of the synthetic cannabinoid K2. Pediatrics. 2011;128(6):E1622–7.
Schmid J, Auer J. Spontaneous coronary artery dissection in a young man—case report. J Cardiothorac Surg. 2011;6:–22.
Trojak B, Leclerq S, Meille V, Khoumri C, Chauvet-Gelinier J-C, Giroud M, et al. Stroke with neuropsychiatric sequelae after cannabis use in a man: a case report. J Med Case Rep. 2011;5:264.
Alao A. Cannabis-induced atrial fibrillation in a patient with traumatic brain injury. J Neuropsychiatry Clin Neurosci SPR. 2012;24(2):21–2.
Arora S, Goyal H, Aggarwal P, Kukar A. ST-segment elevation myocardial infarction in a 37-year-old man with normal coronaries—it is not always cocaine! Am J Emerg Med. 2012;30(9):–2091.e3.
Biyik I, Akturk IF, Yalcin AA, Tanidir IC, Erturk M. Cannabis joint triggered recurrent anterior myocardial infarction in an adolescent taking dual anti-platelet therapy. Postepy W Kardiologii Interwencyjnej. 2012;8(2):156–9.
Broz P, Jaeger KA. Buerger’s disease. Vasc Med. 2012;17(5):366–7.
Dahdouh Z, Roule V, Lognone T, Sabatier R, Grollier G. Cannabis and coronary thrombosis: what is the role of platelets? Platelets. 2012;23(3):243–5.
Diffley M, Armenian P, Gerona R, Reinhartz O, Avasarala K. Catecholaminergic polymorphic ventricular tachycardia found in an adolescent after a methylenedioxymethamphetamine and marijuana-induced cardiac arrest. Crit Care Med. 2012;40(7):2223–6.
Kamat AS, Aliashkevich AF, Denton JR, Fitzjohn TP. Headache after substance abuse: a diagnostic dilemma. J Clin Neurosci. 2012;19(3):464–6.
Melki E, Denier C, Theaudin-Saliou M, Sachet M, Ducreux D, Saliou G. External carotid artery branches involvement in reversible cerebral vasoconstriction syndrome. J Neurol Sci. 2012;313(1–2):46–7.
Pratap B, Korniyenko A. Toxic effects of marijuana on the cardiovascular system. Cardiovasc Toxicol. 2012;12(2):143–8.
Renard D, Taieb G, Gras-Combe G, Labauge P. Cannabis-related myocardial infarction and cardioembolic stroke. J Stroke Cerebrovasc Dis. 2012;21(1):82–3.
Romero-Puche AJ, Trigueros-Ruiz N, Carmen Cerdan-Sanchez M, Perez-Lorente F, Roldan D, Vicente-Vera T. Brugada electrocardiogram pattern induced by cannabis. Rev Esp Cardiol. 2012;65(9):856–8.
Safaa AM, Markham R, Jayasinghe R. Marijuana-induced recurrent acute coronary syndrome with normal coronary angiograms. Drug Alcohol Rev. 2012;31(1):91–4.
Singh NN, Pan Y, Muengtaweeponsa S, Geller TJ, Cruz-Flores S. Cannabis-related stroke: case series and review of literature. J Stroke Cerebrovasc Dis. 2012;21(7):555–60.
Young AC, Schwarz E, Medina G, Obafemi A, Feng S-Y, Kane C, et al. Cardiotoxicity associated with the synthetic cannabinoid, K9, with laboratory confirmation. Am J Emerg Med. 2012;30(7):1320.e5.
Yurtdas M, Aydin MK. Acute myocardial infarction in a young man; fatal blow of the marijuana: a case report. Korean Circ J. 2012;42(9):641–5.
Bucci F, Redler A, Fiengo L. Critical limb ischemia in a young man: saddle embolism or unusual presentation of thromboangiitis obliterans? Case Rep Vasc Med. 2013;2013:830540–0.
Burger BM, Chavis PS, Purvin V. A weed by any other name. Surv Ophthalmol. 2013;58(2):176–83.
Deharo P, Massoure P-L, Fourcade L. Exercise-induced acute coronary syndrome in a 24-year-old man with massive cannabis consumption. Acta Cardiol. 2013;68(4):425–8.
El Scheich T, Weber A-A, Klee D, Schweiger D, Mayatepek E, Karenfort M. Adolescent ischemic stroke associated with anabolic steroid and cannabis abuse. J Pediatr Endocrinol Metab. 2013;26(1–2):161–5.
Freeman MJ, Rose DZ, Myers MA, Gooch CL, Bozeman AC, Burgin WS. Ischemic stroke after use of the synthetic marijuana “spice”. Neurology. 2013;81(24):2090–3.
Khanagavi J, Phatak P, Kolte D, Aronow WS, Lanier G. Synthetic cannabinoids-induced thrombotic microangiopathy leading to acute heart failure. Circulation. 2013;128(22).
Lee KB, Song BG, Kang GH, Park YH. Cannabis smoking and sildenafil citrate induced acute coronary syndrome in a patient with myocardial bridge. Anadolu Kardiyol Derg- Anatol J Cardiol. 2013;13(2):180–1.
Menahem S. Cardiac asystole following cannabis (marijuana) usage—additional mechanism for sudden death? Forensic Sci Int. 2013;233(1–3):E3–5.
Ray WZ, Krisht KM, Schabel A, Schmidt RH. Subarachnoid hemorrhage from a thoracic radicular artery pseudoaneurysm after methamphetamine and synthetic cannabinoid abuse: case report. Glob Spine J. 2013;3(2):119–24.
Robert T, Marchini AK, Oumarou G, Uske A. Reversible cerebral vasoconstriction syndrome identification of prognostic factors. Clin Neurol Neurosurg. 2013;115(11):2351–7.
Sayin MR, Akpinar I, Cetiner MA, Karabag T. Diffuse coronary ectasia and acute coronary syndrome in a young man. Who is guilty? Cannabis, smoking or dyslipidemia? Anadolu Kardiyol Derg- Anatol. J Cardiol. 2013;13(6):616–8.
Baharnoori M, Kassardjian CD, Saposnik G. Cannabis use associated with capsular warning syndrome and ischemic stroke. Can J Neurol Sci. 2014;41(2):272–3.
Bernson-Leung ME, Leung LY, Kumar S. Synthetic cannabis and acute ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23(5):1239–41.
Casier I, Vanduynhoven P, Haine S, Vrints C, Jorens PG. Is recent cannabis use associated with acute coronary syndromes? An illustrative case series. Acta Cardiol. 2014;69(2):131–6.
Corvi F, Querques G, Lattanzio R, Preziosa C, Parodi MB, Bandello F. Central retinal vein occlusion in a young patient following cannabis smoke inhalation. Eur J Ophthalmol. 2014;24(3):437–40.
Fogang YF, Camara M, Mbonda PC, Toffa D, Toure K. Late onset epilepsy associated with marijuana abuse: a case report with MRI findings. Pan Afr Med J. 2014;17:158–8.
Gunawardena MDVM, Rajapakse S, Herath J, Amarasena N. Myocardial infarction following cannabis induced coronary vasospasm. BMJ Case Rep. 2014;2014.
Hartung B, Kauferstein S, Ritz-Timme S, Daldrup T. Sudden unexpected death under acute influence of cannabis. Forensic Sci Int. 2014;237:E11–3.
Hodcroft CJ, Rossiter MC, Buch AN. Cannabis-associated myocardial infarction in a young man with normal coronary arteries. J Emerg Med. 2014;47(3):277–81.
Ibrahim S, Al-Saffar F, Wannenburg T. A unique case of cardiac arrest following K2 abuse. Case Rep Cardiol. 2014;2014:120607–7.
Ibrir M, Ouadahi N, Hamzaoui N, Zemmour D, Ghita DH, Habouchi A, et al. Peripheral arteritis disease and ischemic strokes in cannabis use: a case report. Thromb Res. 2014;133:S115–6.
Inal T, Kose A, Koksal O, Armagan E, Aydin SA, Ozdemir F. Acute temporal lobe infarction in a young patient associated with marijuana abuse: an unusual cause of stroke. World J Emerg Med. 2014;5(1):72–4.
Lee C, Moll S. Migratory superficial thrombophlebitis in a cannabis smoker. Circulation. 2014;130(2):214–5.
Nogi M, Fergusson D, Chiaco JMC. Mid-ventricular variant takotsubo cardiomyopathy associated with cannabinoid hyperemesis syndrome: a case report. Hawaii J Med Public Health J Asia Pac Med Public Health. 2014;73(4):115–8.
Nouh A, Ruland S, Schneck MJ, Pasquale D, Biller J. Reversible cerebral vasoconstriction syndrome with multivessel cervical artery dissections and a double aortic arch. J Stroke Cerebrovasc Dis. 2014;23(2):E141–3.
Oyinloye O, Nzeh D, Yusuf A, Sanya E. Ischemic stroke following abuse of marijuana in a Nigerian adult male. J Neurosci Rural Pract. 2014;5(4):417–9.
Pape E, Roman E, Frikha Z, Scala-Bertola J, Tournebize J, Bornert-Keller N, et al. Acute myocardial infarction in a cannabis smoker: role of cannabis? Fundam Clin Pharmacol. 2014;28:57–7.
Rodriguez-Castro CE, Alkhateeb H, Elfar A, Saifuddin F, Abbas A, Siddiqui T. Recurrent myopericarditis as a complication of marijuana use. Am J Case Rep. 2014;15:60–2.
Santos AF, Rodrigues M, Mare R, Ferreira C, Soares-Fernandes J, Rocha J. Recurrent stroke in a young cannabis user. J Neuropsychiatry Clin Neurosci WIN. 2014;26(1):E41–2.
Takematsu M, Hoffman RS, Nelson LS, Schechter JM, Moran JH, Wiener SW. A case of acute cerebral ischemia following inhalation of a synthetic cannabinoid. Clin Toxicol. 2014;52(9):973–5.
Tse R, Kodur S, Squires B, Collins N. Sudden cardiac death complicating acute myocardial infarction following synthetic cannabinoid use. Intern Med J. 2014;44(9):934–6.
Tsivgoulis G, Lachanis S, Papathanasiou MA, Chondrogianni M, Brountzos EN, Voumvourakis K. Cannabis-associated angiopathy an uncommon cause of crescendo transient ischemic attacks. Circulation. 2014;130(23):2069–70.
Atik SU, Dedeoglu R, Varol F, Cam H, Eroglu AG, Saltik L. Cardiovascular side effects related with use of “bonzai”: two case reports. Turk Pediatri Arsivi-Turk Arch Pediatr. 2015;50(1):61–4.
Bui QM, Simpson S, Nordstrom K. Psychiatric and medical management of marijuana intoxication in the emergency department. West J Emerg Med. 2015;16(3):414–7.
Clark BC, Georgekutty J, Berul CI. Myocardial ischemia secondary to synthetic cannabinoid (K2) use in pediatric patients. J Pediatr. 2015;167(3):757–61.
Davis C, Boddington D. Teenage cardiac arrest following abuse of synthetic cannabis. Heart Lung Circ. 2015;24(10):E162–3.
Domi R, Janko A, Sula H. An unusual postoperative cerebral ischemic stroke. J Anesth. 2015;29(1):157–7.
Ince B, Benbir G, Yuksel O, Koseoglu L, Uluduz D. Both hemorrhagic and ischemic stroke following high doses of cannabis consumption. Presse Med. 2015;44(1):106–7.
Jehangir W, Stanton M, Khan R, Sahgal P, Yousif A. Did cannabis precipitate an STEMI in a young woman? Cardiol Res. 2015;6(3):283–5.
Koklu E, Yuksel IO, Bayar N, Ureyen CM, Arslan S. A new cause of silent myocardial infarction: bonsai. Anadolu Kardiyol Derg- Anatol J Cardiol. 2015;15(1):69–70.
Lou J-Y, Randhawa MS, Hornacek D, Bajzer C. Spontaneous renal artery dissection in a cannabis user. Vasc Med. 2015;20(4):379–80.
McKeever RG, Vearrier D, Jacobs D, LaSala G, Okaneku J, Greenberg MI. K2—not the spice of life; synthetic cannabinoids and ST elevation myocardial infarction: a case report. J Med Toxicol Off J Am Coll Med Toxicol. 2015;11(1):129–31.
Ntlholang O, McDonagh R, Donnelly S, Brett F, Bradley D, Harbison J. Is intracranial arterial stenosis found in cannabis related stroke due to intimal hyperplasia? Int J Stroke. 2015;10:240–1.
Porterfield DOH, Ashby Md M, Newman Md WP, McGoey MR. Pathology image of the month: mitral stenosis at autopsy. J La State Med Soc Off Organ La State Med Soc. 2015;167(3):144–6.
Rose DZ, Guerrero WR, Mokin MV, Gooch CL, Bozeman AC, Pearson JM, et al. Hemorrhagic stroke following use of the synthetic marijuana “spice”. Neurology. 2015;85(13):1177–9.
Sherpa D, Paudel BM, Subedi BH, Chow RD. Synthetic cannabinoids: the multi-organ failure and metabolic derangements associated with getting high. J Community Hosp Intern Med Perspect. 2015;5(4):27540.
Tormey WP. Newspaper reports from the Coroners Court in Ireland are used to reveal the potential complexity and need for reform in forensic toxicology and medicine services. J Forensic Legal Med. 2015;32:47–52.
Velibey Y, Tanik O, Keskin M, Bolca O, Eren M, et al. Am J Emerg Med. 2015;33(8):1114.e1.
Whitlock JB, Robinson GT, Whitlock JP, Dredla BK, Barrett KM. Mystery case: A 21-year-old man with visual loss following marijuana use. Neurology. 2015;84(21):E165–9.
Yau WY, Chu E, Lai N. Cannabis, serotonergic drug use and stroke in a 50-year-old woman. Intern Med J. 2015;45(12):1312–3.
Degirmenci Y, Kececi H, Olmez N. A case of ischemic stroke after bonzai: syntetic cannabinoid from Turkey. Neurol Sci. 2016;37(2):299–300.
Elsheshtawy M, Sriganesh P, Virparia V, Patel F, Khanna A. Synthetic marijuana induced acute nonischemic left ventricular dysfunction. Case Rep Cardiol. 2016;2016:9625758.
Marchetti D, Spagnolo A, De Matteis V, Filograna L, De Giovanni N. Coronary thrombosis and marijuana smoking: a case report and narrative review of the literature. Drug Test Anal. 2016;8(1):56–62.
McIlroy G, Ford L, Khan JM. Acute myocardial infarction, associated with the use of a synthetic adamantyl-cannabinoid: a case report. BMC Pharmacol Toxicol. 2016;17:2.
Roberts JA, Meyer J-P. Buerger’s disease presenting as a testicular mass: a rare presentation of an uncommon disease. Urol Ann. 2016;8(2):249–51.
Shah M, Garg J, Patel B, Guthier J, Freudenberger RS. Can your heart handle the spice: a case of acute myocardial infarction and left ventricular apical thrombus. Int J Cardiol. 2016;215:129–31.
Shanks KG, Clark W, Behonick G. Death associated with the use of the synthetic cannabinoid ADB-FUBINACA. J Anal Toxicol. 2016;40(3):236–9.
Tournebize J, Gibaja V, Puskarczyk E, Popovic B, Kahn J-P. Myocarditis associated with cannabis use in a 15-year-old boy: a rare case report. Int J Cardiol. 2016;203:243–4.
Zaleta S, Kumar P, Miller S. Chest pain, troponin rise, and ST-elevation in an adolescent boy following the use of the synthetic cannabis product K2. Ann Pediatr Cardiol. 2016;9(1):79–81.
Forrester MB, Kleinschmidt K, Schwarz E, Young A. Synthetic cannabinoid exposures reported to Texas poison centers. J Addict Dis. 2011;30(4):351–8.
Jouanjus E, Leymarie F, Tubery M, Lapeyre-Mestre M. Cannabis-related hospitalizations: unexpected serious events identified through hospital databases. Br J Clin Pharmacol. 2011;71(5):758–65.
Martin-Blondel G, Koskas F, Cacoub P, Sene D. Is thromboangiitis obliterans presentation influenced by cannabis addiction? Ann Vasc Surg. 2011;25(4):469–73.
Mondy KE, Gottdiener J, Overton ET, Henry K, Bush T, Conley L, et al. High prevalence of echocardiographic abnormalities among HIV-infected persons in the era of highly active antiretroviral therapy. Clin Infect Dis. 2011;52(3):378–86.
• Nawrot TS, Perez L, Kuenzli N, Munters E, Nemery B. Public health importance of triggers of myocardial infarction: a comparative risk assessment. Lancet. 2011;377(9767):732–40. This meta-analysis, based on the epidemiologic data published between 1960 and 2010, identified cannabis as one of the 13 triggering factors of myocardial infarctions.
• Wolff V, Lauer V, Rouyer O, Sellal F, Meyer N, Raul JS, et al. Cannabis use, ischemic stroke, and multifocal intracranial vasoconstriction a prospective study in 48 consecutive young patients. Stroke. 2011;42(6):1778–80. Presents a series of stroke patients, with very complete clinical features and exhaustive etiological characterization. Although the number of patients is low, the case series displayed a specific pattern of cannabis-related stroke (i.e., multifocal intracranial stenosis)
Forrester MB. Adolescent synthetic cannabinoid exposures reported to Texas poison centers. Pediatr Emerg Care. 2012;28(10):985–9.
Hoyte CO, Jacob J, Monte AA, Al-Jumaan M, Bronstein AC, Heard KJ. A characterization of synthetic cannabinoid exposures reported to the National Poison Data System in 2010. Ann Emerg Med. 2012;60(4):435–8.
• Barber PA, Pridmore HM, Krishnamurthy V, Roberts S, Spriggs DA, Carter KN, et al. Cannabis, ischemic stroke, and transient ischemic attack a case-control study. Stroke. 2013;44(8):2327–9. This study is one of the rare case-control studies done on the topic of cardiovascular complications associated with cannabis use
Berard AM, Bedel A, Le Trequesser R, Freyburger G, Nurden A, Colomer S, et al. Novel risk factors for premature peripheral arterial occlusive disease in non-diabetic patients: a case-control study. PLoS One. 2013;8(3):e37882.
• Frost L, Mostofsky E, Rosenbloom JI, Mukamal KJ, Mittleman MA. Marijuana use and long-term mortality among survivors of acute myocardial infarction. Am Heart J. 2013;165(2):170–5. A study conducted from the same cohort explored by Mittleman et al. in 2001, using robust methodology, but lacking potency
Hermanns-Clausen M, Kneisel S, Szabo B, Auwaerter V. Acute toxicity due to the confirmed consumption of synthetic cannabinoids: clinical and laboratory findings. Addiction. 2013;108(3):534–44.
Morentin B, Ballesteros J, Callado LF, Javier MJ. Recent cocaine use is a significant risk factor for sudden cardiovascular death in 15-49-year-old subjects: a forensic case-control study. Addiction. 2014;109(12):2071–8.
Soussan C, Kjellgren A. The flip side of “spice”: the adverse effects of synthetic cannabinoids as discussed on a Swedish Internet forum. Nord Stud Alcohol Drugs. 2014;31(2):207–19.
Wolff V, Armspach J-P, Beaujeux R, Manisor M, Rouyer O, Lauer V, et al. High frequency of intracranial arterial stenosis and cannabis use in ischaemic stroke in the young. Cerebrovasc Dis. 2014;37(6):438–43.
Wolff V, Armspach J-P, Lauer V, Rouyer O, Ducros A, Marescaux C, et al. Ischaemic strokes with reversible vasoconstriction and without thunderclap headache: a variant of the reversible cerebral vasoconstriction syndrome? Cerebrovasc Dis. 2015;39(1):31–8.
Bechtold J, Simpson T, White HR, Pardini D. Chronic adolescent marijuana use as a risk factor for physical and mental health problems in young adult men. Psychol Addict Behav. 2015;29(3):552–63.
Besli GE, Ikiz MA, Yildirim S, Saltik S. Synthetic cannabinoid abuse in adolescents: a case series. J Emerg Med. 2015;49(5):644–50.
Dines AM, Wood DM, Galicia M, Yates CM, Heyerdahl F, Hovda KE, et al. Presentations to the emergency department following cannabis use—a multi-centre case series from ten European countries. J Med Toxicol Off J Am Coll Med Toxicol. 2015;11(4):415–21.
Onyeka IN, Beynon CM, Ronkainen K, Tiihonen J, Fohr J, Kuikanmaki O, et al. Hospitalization in a cohort seeking treatment for illicit drug use in Finland. J Subst Abus Treat. 2015;53:64–70.
Wolff V, Zinchenko I, Quenardelle V, Rouyer O, Geny B. Characteristics and prognosis of ischemic stroke in young cannabis users compared with non-cannabis users. J Am Coll Cardiol. 2015;66(18):2052–3.
Behrouz R, Birnbaum L, Grandhi R, Johnson J, Misra V, Palacio S, et al. Cannabis use and outcomes in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2016;47(5):1371–3.
Dogan H, Ozucelik DN, Aciksari K, Avci A, Yazicioglu M, Celikmen MF, et al. New synthetic cannabinoid intoxications in emergency department (it’s grass, it’s no sin). Anadolu Psikiyatri Derg-Anatol J Psychiatry. 2016;17(1):18–25.
• Hemachandra D, McKetin R, Cherbuin N, Anstey KJ. Heavy cannabis users at elevated risk of stroke: evidence from a general population survey. Aust N Z J Public Health. 2016;40(3):226–30. Cannabis use in the past year was associated with a 3.3 fold higher rate of stroke/TIA (95%CI 1.8-6.3) in a representative sample of the general Australian population. This association remained although it reduced to 2.3 (95%CI 1.1-4.5) after adjustment for covariates including tobacco smoking.
Hermanns-Clausen M, Kithinji J, Spehl M, Angerer V, Franz F, Eyer F, et al. Adverse effects after the use of JWH-210—a case series from the EU Spice II plus project. Drug Test Anal. 2016;8(10):1030–1038.
•• Rumalla K, Reddy AY, Mittal MK. Recreational marijuana use and acute ischemic stroke: a population-based analysis of hospitalized patients in the United States. J Neurol Sci. 2016;364:191–6. This reference corresponds to cohort studies, conducted from a wide database, and provides robust results
Rumalla K, Reddy AY, Mittal MK. Association of recreational marijuana use with aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 2016;25(2):452–60.
Waugh J, Najafi J, Hawkins L, Hill SL, Eddleston M, Vale JA, et al. Epidemiology and clinical features of toxicity following recreational use of synthetic cannabinoid receptor agonists: a report from the United Kingdom National Poisons Information Service. Clin Toxicol Phila Pa. 2016;54(6):512–8.
Karschner EL, Darwin WD, McMahon RP, Liu F, Wright S, Goodwin RS, et al. Subjective and physiological effects after controlled Sativex and oral THC administration. Clin Pharmacol Ther. 2011;89(3):400–7.
Bedi G, Cooper ZD, Haney M. Subjective, cognitive and cardiovascular dose-effect profile of nabilone and dronabinol in marijuana smokers. Addict Biol. 2013;18(5):872–81.
Jicha CJ, Lofwall MR, Nuzzo PA, Babalonis S, Elayi SC, Walsh SL. Safety of oral dronabinol during opioid withdrawal in humans. Drug Alcohol Depend. 2015;157:179–83.
Williams JC, Klein TW, Goldberger BA, Sleasman JW, Mackman N, Goodenow MM. Δ(9)-Tetrahydrocannabinol (THC) enhances lipopolysaccharide-stimulated tissue factor in human monocytes and monocyte-derived microvesicles. J Inflamm Lond Engl. 2015;12:39.
De Angelis V, Koekman AC, Weeterings C, Roest M, de Groot PG, Herczenik E, et al. Endocannabinoids control platelet activation and limit aggregate formation under flow. PLoS One. 2014;9(9):e108282.
European Monitoring Centre for Drug and Drug Addiction (EMCDDA). EMCDDA | Perspectives on drugs: characteristics of frequent and high-risk cannabis users [Internet]. 2013 [accessed 30 August 2016]. Available from: http://www.emcdda.europa.eu/topics/pods/frequent-cannabis-users
Mukamal KJ, Maclure M, Muller JE, Mittleman MA. An exploratory prospective study of marijuana use and mortality following acute myocardial infarction. Am Heart J. 2008;155(3):465–70.
Acknowledgements
The authors thank the professionals from Toulouse University library, in particular Agnès Thiercelin, as well as Nathalie Bel, from the public health and clinical research documentation center (Centre Régional de Documentation en Santé Publique et Recherche Clinique, Inserm UMR 1027) for the precious time they took to answer our questions concerning the databases explored in this review.
Authors’ Contribution
EJ and VR: conception and design, search algorithm, literature search, analysis and interpretation of data, writing of the first draft, and critical revision of the article draft for preparing the final version. MLM: conception and design, analysis, and critical revision of the article draft for preparing the final version. VW: conception and design and critical revision of the article draft for preparing the final version.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Emilie Jouanjus, Valentin Raymond, Maryse Lapeyre-Mestre, and Valérie Wolff declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Dr. Jouanjus and Dr. Raymond would like to share first authorship.
This article is part of the Topical Collection on Coronary Heart Disease
Electronic Supplementary Material
ESM 1
(XLSX 35 kb)
Rights and permissions
About this article
Cite this article
Jouanjus, E., Raymond, V., Lapeyre-Mestre, M. et al. What is the Current Knowledge About the Cardiovascular Risk for Users of Cannabis-Based Products? A Systematic Review. Curr Atheroscler Rep 19, 26 (2017). https://doi.org/10.1007/s11883-017-0663-0
Published:
DOI: https://doi.org/10.1007/s11883-017-0663-0