Cannabis is the most commonly consumed illicit drug. It is estimated that 4% of the global population between the ages of 15 and 64 smoked marijuana in 2003. Despite the drug’s extreme popularity, reports of cannabis-related stroke and myocardial infarction are so rare as to still be reportable. Cannabinoids, the active compounds contained in marijuana, interact with cardiovascular centers in the brain, but also exert direct effects on vascular tone. Recent animal and in vitro studies have yielded conflicting results, some suggesting minimal effect, others suggesting that cannabinoids may be potent myocardial depressants. The observation that cardiotoxicity has never been reported in cancer patients taking dronabinol, the synthetic form of THC, tends to suggest that animal studies may have overstated the cardiovascular risk, which is probably comparable to that of smoking cigarettes.
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UN Office for Drug Control and Crime Prevention. World Drug Report for 2005. Geneva: United Nations, Office on Drugs and Crime, 2005.
Studies, O.o.A. National Survey on Drug Use & Health. Bethesda, MD: Substance Abuse and Mental Health Services Administration, 2005.
American Heart Association. Heart disease and stroke statistics —2005 update. Dallas, TX: author, 2005.
Charles R, Holt S, Kirkham N. Myocardial infarction and marijuana. Clin Toxicol 1979;14(4):433–438.
Collins JS, Higginson JD, Webb SW. Myocardial infarction during marijuana smoking in a young female. Eur Heart J 1985;6(7):637–638.
Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation 2001;103(23):2805–2809.
Lindsay AC, Foale RA, Warren, Henry JA. Cannabis as a precipitant of cardiovascular emergencies. Int J Cardiol 2005; 104(2):230–232.
Caldicott DG, Holmes J, Roberts-Thomson KC, Mahar L. Keep off the grass: marijuana use and acute cardiovascular events. Eur J Emerg Med 2005;12(5):236–244.
Jones RT. Cardiovascular system effects of marijuana. J Clin Pharmacol 2002;42(11 Suppl):58S-63S.
Servoss SJ, Januzzi JL, Muller JE. Triggers of acute coronary syndromes. Prog Cardiovasc Dis 2002;44(5):369–380.
Virmani R, Burke AP, Farb A. Sudden cardiac death. Cardiovasc Pathol 2001;10(5):211–218.
Bachs L, Morland H. Acute cardiovascular fatalities following cannabis use. Forensic Sci Int 2001;124(2–3):200–203.
Fisher BA, Ghuran A, Vadamalai V, Antonios TF. Cardiovascular complications induced by cannabis smoking: a case report and review of the literature. Emerg Med J 2005;22(9):679–680.
Nattel S. Can losartan prevent new-onset atrial fibrillation in hypertensive patients more effectively than atenolol? Nat Clin Pract Cardiovasc Med 2005;2(7):332–333.
Wagner JA, Abesser M, Karcher J, Laser M, Kunos G. Coronary vasodilator effects of endogenous cannabinoids in vasopressin-preconstricted unpaced rat isolated hearts. J Cardiovasc Pharmacol 2005;46(3):348–355.
Thakur GA, Nikas SP, Makriyannis A. CB1 cannabinoid receptor ligands. Mini Rev Med Chem 2005;5(7):631–640.
Huffman JW. CB2 receptor ligands. Mini Rev Med Chem 2005;5(7):641–649.
Ueda N, Okamoto Y, Tsuboi K. Endocannabinoid-related enzymes as drug targets with special reference to N-acylphosphatidylethamolamine-hydrolyzing phospholipase D. Curr Med Chem 2005;12(12):1413–1422.
Bisogno T, Ligresti A, Di Marzo V. The endocannabinoid signalling system: biochemical aspects. Pharmacol Biochem Behav 2005;81(2):224–238.
ElSohly M, Slade D. Chemical constituents of marijuana: the complex mixture of natural cannabinoids. Life Sci 2005;2005 (e-published ahead of schedule).
Mechoulam R, Hanus L. A historical overview of chemical research on cannabinoids. Chem Phys Lipids 2000;108(1–2):1–13.
Batkai S, Pacher P, Osei-Hyiaman D, et al. Endocannabinoids acting at cannabinoid-1 receptors regulate cardiovascular function in hypertension. Circulation 2004;110(14):1996–2002.
Benowitz NL, Jones RT. Cardiovascular effects of prolonged delta-9-tetrahydrocannabinol ingestion. Clin Pharmacol Ther 1975;18(3):287–297.
O’Sullivan SE, Tarling EJ, Bennett AJ, Kendall DA, Randall MD. Novel time-dependent vascular actions of Delta9-tetrahydrocannabinol mediated by peroxisome proliferator-activated receptorgamma. Biochem Biophys Res Commun 2005;337(3):824–831.
Newlin D, Pretorius MB, Wong CJ, Dax EM. Acute marijuana smoking reduces vagal tone. NIDA Res Monogr 1991;(105):565–565.
Anon. Youth Tobacco Surveillance—United States 2000, in Surveillance Summaries. Atlanta, GA: Center of Disease Control, 2001, pp. 1–84.
Bradford-Hill A. The environment and disease: Association or causation? President’s address. Proceedings of the Royal Society of Medicine. 1965;9:295–300.
Chen Z, Boreham J. Smoking and cardiovascular disease. Semin Vasc Med 2002;2(3):243–252.
Sidney S. Cardiovascular consequences of marijuana use. J Clin Pharmacol 2002;42(11 Suppl):64S-70S.
Aronow WS, Cassidy J. Effect of marihuana and placebomarihuana smoking on angina pectoris. N Engl J Med 1974; 291(2):65–67.
Mouzak A, Agathos P, Kerezoudi E, Mantas A, Vourdeli-Yiannakoura E. Transient ischemic attack in heavy cannabis smokers—how ‘safe’ is it? Eur Neurol 2000;44(1):42–44.
Cooles P, Michaud R. Stroke after heavy cannabis smoking. Postgrad Med J 1987;63(740):511.
Zachariah SB. Stroke after heavy marijuana smoking. Stroke 1991;22(3):406–409.
White D, et al. Stroke associated with marijuana abuse. Pediatr Neurosurg 2000;32:92–94.
Gupta BD, Jani CB, Shah PH. Fatal ‘Bhang’ poisoning. Med Sci Law 2001;41(4):349–352.
Finsterer J, Christian P, Wolfgang K. Occipital stroke shortly after cannabis consumption. Clin Neurol Neurosurg 2004; 106(4):305–308.
Geller T, Loftis L, Brink D. Cerebellar infarction in adolescent males associated with acute marijuana abuse. Pediatrics 2004;106:305–308.
Coros C, Sorce A. PDR 60th edition. Montvale, NJ: Thompson-PDR.
Garrett ER, Hunt CA. Physiochemical properties, solubility, and protein binding of delta9-tetrahydrocannabinol. J Pharm Sci 1974;63(7):1056–1064.
Agurell S, Leander K. Stability, transfer and absorption of cannabinoid constituents of cannabis (hashish) during smoking. Acta Pharm Suec 1971;8(4):391–402.
Wahlqvist M, Nilsson IM, Sandberg F, Agurell S. Binding of delta-1-tetrahydrocannabinol to human plasma proteins. Biochem Pharmacol 1970;19(9):2579–2584.
Lemberger L, Tamarkin NR, Axelrod J, Kopin IJ. Delta-9-tetrahydrocannabinol: metabolism and disposition in long-term marihuana smokers. Science 1971;173(991):72–74.
Kreuz DS, Axelrod J. Delta-9-tetrahydrocannabinol: localization in body fat. Science 1973;179(71):391–393.
Levisky JA, Bowerman DL, Jenkins WW, Johnson DG, Karch SB. Drugs in postmortem adipose tissues: evidence of antemortem deposition. Forensic Sci Int 2001;121(3):157–160.
Johnson JR, Jennison TA, Peat MA, Foltz RL. Stability of delta 9-tetrahydrocannabinol (THC), 11-hydroxy-THC, and 11-nor-9-carboxy-THC in blood and plasma. J Anal Toxicol 1984; 8(5):202–204.
McCurdy HH, Callahan LS, Williams RD. Studies on the stability and detection of cocaine, benzoylecgonine, and 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid in whole blood using Abuscreen radioimmunoassay. J Forensic Sci 1989;34(4):858–870.
Christophersen AS. Tetrahydrocannabinol stability in whole blood: plastic versus glass containers. J Anal Toxicol 1986; 10(4):129–131.
Diez JJ, Iglesias P. The role of the novel adipocyte-derived hormone adiponectin in human disease. Eur J Endocrinol 2003;147(3):293–300.
Huestis MA, Gorelick DA, Heishman SJ, et al. Blockade of effects of smoked marijuana by the CB1-selective cannabinoid receptor antagonist SR141716. Arch Gen Psychiatry 2001; 58(4):322–328.
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Karch, S.B. Cannabis and cardiotoxicity. Forens Sci Med Pathol 2, 13–18 (2006). https://doi.org/10.1385/FSMP:2:1:13
- coronary artery disease
- sudden cardiac death