Skip to main content

Cannabis and cardiotoxicity

Forensic Science, Medicine, and Pathology volume 2, pages 13–18 (2006)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. UN Office for Drug Control and Crime Prevention. World Drug Report for 2005. Geneva: United Nations, Office on Drugs and Crime, 2005.

    Google Scholar 

  2. Studies, O.o.A. National Survey on Drug Use & Health. Bethesda, MD: Substance Abuse and Mental Health Services Administration, 2005.

    Google Scholar 

  3. American Heart Association. Heart disease and stroke statistics —2005 update. Dallas, TX: author, 2005.

    Google Scholar 

  4. Charles R, Holt S, Kirkham N. Myocardial infarction and marijuana. Clin Toxicol 1979;14(4):433–438.

    PubMed  CAS  Google Scholar 

  5. Collins JS, Higginson JD, Webb SW. Myocardial infarction during marijuana smoking in a young female. Eur Heart J 1985;6(7):637–638.

    PubMed  CAS  Google Scholar 

  6. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation 2001;103(23):2805–2809.

    PubMed  CAS  Google Scholar 

  7. Lindsay AC, Foale RA, Warren, Henry JA. Cannabis as a precipitant of cardiovascular emergencies. Int J Cardiol 2005; 104(2):230–232.

    PubMed  Article  Google Scholar 

  8. 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.

    PubMed  Article  Google Scholar 

  9. Jones RT. Cardiovascular system effects of marijuana. J Clin Pharmacol 2002;42(11 Suppl):58S-63S.

    PubMed  CAS  Google Scholar 

  10. Servoss SJ, Januzzi JL, Muller JE. Triggers of acute coronary syndromes. Prog Cardiovasc Dis 2002;44(5):369–380.

    PubMed  Article  Google Scholar 

  11. Virmani R, Burke AP, Farb A. Sudden cardiac death. Cardiovasc Pathol 2001;10(5):211–218.

    PubMed  Article  CAS  Google Scholar 

  12. Bachs L, Morland H. Acute cardiovascular fatalities following cannabis use. Forensic Sci Int 2001;124(2–3):200–203.

    PubMed  Article  CAS  Google Scholar 

  13. 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.

    PubMed  Article  CAS  Google Scholar 

  14. 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.

    PubMed  Article  Google Scholar 

  15. 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.

    PubMed  Article  CAS  Google Scholar 

  16. Thakur GA, Nikas SP, Makriyannis A. CB1 cannabinoid receptor ligands. Mini Rev Med Chem 2005;5(7):631–640.

    PubMed  Article  CAS  Google Scholar 

  17. Huffman JW. CB2 receptor ligands. Mini Rev Med Chem 2005;5(7):641–649.

    PubMed  Article  CAS  Google Scholar 

  18. 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.

    PubMed  Article  CAS  Google Scholar 

  19. Bisogno T, Ligresti A, Di Marzo V. The endocannabinoid signalling system: biochemical aspects. Pharmacol Biochem Behav 2005;81(2):224–238.

    PubMed  Article  CAS  Google Scholar 

  20. ElSohly M, Slade D. Chemical constituents of marijuana: the complex mixture of natural cannabinoids. Life Sci 2005;2005 (e-published ahead of schedule).

  21. Mechoulam R, Hanus L. A historical overview of chemical research on cannabinoids. Chem Phys Lipids 2000;108(1–2):1–13.

    PubMed  Article  CAS  Google Scholar 

  22. 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.

    PubMed  Article  CAS  Google Scholar 

  23. Benowitz NL, Jones RT. Cardiovascular effects of prolonged delta-9-tetrahydrocannabinol ingestion. Clin Pharmacol Ther 1975;18(3):287–297.

    PubMed  CAS  Google Scholar 

  24. 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.

    PubMed  CAS  Article  Google Scholar 

  25. Newlin D, Pretorius MB, Wong CJ, Dax EM. Acute marijuana smoking reduces vagal tone. NIDA Res Monogr 1991;(105):565–565.

    Google Scholar 

  26. Anon. Youth Tobacco Surveillance—United States 2000, in Surveillance Summaries. Atlanta, GA: Center of Disease Control, 2001, pp. 1–84.

  27. Bradford-Hill A. The environment and disease: Association or causation? President’s address. Proceedings of the Royal Society of Medicine. 1965;9:295–300.

    Google Scholar 

  28. Chen Z, Boreham J. Smoking and cardiovascular disease. Semin Vasc Med 2002;2(3):243–252.

    PubMed  Article  Google Scholar 

  29. Sidney S. Cardiovascular consequences of marijuana use. J Clin Pharmacol 2002;42(11 Suppl):64S-70S.

    PubMed  CAS  Google Scholar 

  30. Aronow WS, Cassidy J. Effect of marihuana and placebomarihuana smoking on angina pectoris. N Engl J Med 1974; 291(2):65–67.

    PubMed  CAS  Article  Google Scholar 

  31. 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.

    PubMed  Article  CAS  Google Scholar 

  32. Cooles P, Michaud R. Stroke after heavy cannabis smoking. Postgrad Med J 1987;63(740):511.

    PubMed  CAS  Article  Google Scholar 

  33. Zachariah SB. Stroke after heavy marijuana smoking. Stroke 1991;22(3):406–409.

    PubMed  CAS  Google Scholar 

  34. White D, et al. Stroke associated with marijuana abuse. Pediatr Neurosurg 2000;32:92–94.

    PubMed  Article  CAS  Google Scholar 

  35. Gupta BD, Jani CB, Shah PH. Fatal ‘Bhang’ poisoning. Med Sci Law 2001;41(4):349–352.

    PubMed  CAS  Google Scholar 

  36. Finsterer J, Christian P, Wolfgang K. Occipital stroke shortly after cannabis consumption. Clin Neurol Neurosurg 2004; 106(4):305–308.

    PubMed  Article  Google Scholar 

  37. Geller T, Loftis L, Brink D. Cerebellar infarction in adolescent males associated with acute marijuana abuse. Pediatrics 2004;106:305–308.

    Google Scholar 

  38. Coros C, Sorce A. PDR 60th edition. Montvale, NJ: Thompson-PDR.

  39. Garrett ER, Hunt CA. Physiochemical properties, solubility, and protein binding of delta9-tetrahydrocannabinol. J Pharm Sci 1974;63(7):1056–1064.

    PubMed  Article  CAS  Google Scholar 

  40. Agurell S, Leander K. Stability, transfer and absorption of cannabinoid constituents of cannabis (hashish) during smoking. Acta Pharm Suec 1971;8(4):391–402.

    PubMed  CAS  Google Scholar 

  41. Wahlqvist M, Nilsson IM, Sandberg F, Agurell S. Binding of delta-1-tetrahydrocannabinol to human plasma proteins. Biochem Pharmacol 1970;19(9):2579–2584.

    PubMed  Article  CAS  Google Scholar 

  42. 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.

    PubMed  Article  CAS  Google Scholar 

  43. Kreuz DS, Axelrod J. Delta-9-tetrahydrocannabinol: localization in body fat. Science 1973;179(71):391–393.

    PubMed  Article  CAS  Google Scholar 

  44. 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.

    PubMed  Article  CAS  Google Scholar 

  45. 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.

    PubMed  CAS  Google Scholar 

  46. 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.

    PubMed  CAS  Google Scholar 

  47. Christophersen AS. Tetrahydrocannabinol stability in whole blood: plastic versus glass containers. J Anal Toxicol 1986; 10(4):129–131.

    PubMed  CAS  Google Scholar 

  48. Diez JJ, Iglesias P. The role of the novel adipocyte-derived hormone adiponectin in human disease. Eur J Endocrinol 2003;147(3):293–300.

    Article  Google Scholar 

  49. 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.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Consultant in Cardiac Pathology/Toxicology, P.O. Box 5139, 94705, Berkeley, CA

    Steven B. Karch

Authors
  1. Steven B. Karch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven B. Karch.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Karch, S.B. Cannabis and cardiotoxicity. Forens Sci Med Pathol 2, 13–18 (2006). https://doi.org/10.1385/FSMP:2:1:13

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1385/FSMP:2:1:13

Key words

  • THC
  • cannabinoids
  • coronary artery disease
  • sudden cardiac death