Cardiovascular Research

A Review of Cardiovascular Effects of Marijuana Use.

Authors: Shereif H Rezkalla|||Robert A Kloner

Affiliations: + Expand

Abstract

Cannabinoids exert their effects on body tissues via cannabinoid 1 (CB 1 ) and cannabinoid 2 (CB 2 ) receptors. Receptors are present in brain, myocardium, vascular endothelium, platelets, and adipose tissues. Under normal physiologic conditions, endocannabinoid effects are minimal. The use of exogenous cannabis leads to endothelial dysfunction and increases vascular thrombosis via CB 1 receptor stimulation. On the other hand, CB 2 receptors may have a beneficial anti-inflammatory response.

---

Chemical List

Cannabinoids

---

Reference List

Phillips KT, Pedula KL, Choi NG, et al. Chronic health conditions, acute health events, and healthcare utilization among adults over age 50 in Hawai’i who use cannabis: a matched cohort study. Drug Alcohol Depend. 2022;234:109387. doi:10.1016/j.drugalcdep.2022.109387.|||Bahji A, Hathaway J, Adams D, et al. Cannabis use disorder and adverse cardiovascular outcomes: a population-based retrospective cohort analysis of adults from Alberta, Canada. Addiction. 2024;119(1):137-148.doi:10.1111/add.16337.|||Jeffers AM, Glantz S, Byers AL, Keyhani S. Association of cannabis use with cardiovascular outcomes among US adults. J Am Heart Assoc. 2024;13(5):e030178. doi:10.1161/JAHA.123.030178.|||Shah S, Patel S, Paulraj S, Chaudhuri D. Association of marijuana use and cardiovascular disease: a behavioral risk factor surveillance system data analysis of 133,706 US adults. Am J Med. 2021;134(5):614-620.e1. doi:10.1016/j.amjmed.2020.10.019.|||Winhusen T, Theobald J, Kaelber DC, Lewis D. The association between regular cannabis use, with and without tobacco co-use, and adverse cardiovascular outcomes: cannabis may have a greater impact in non-tobacco smokers. Am J Drug Alcohol Abuse. 2020;46(4):454-461. doi:10.1080/00952990.2019.1676433.|||Auer R, Sidney S, Goff D, et al. Lifetime marijuana use and subclinical atherosclerosis: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Addiction. 2018;113(5):845-856.doi:10.1111/add.14110.|||Adamson M, Di Giovanni B, Delgado DH. The positive and negative cardiovascular effects of cannabis. Expert Rev Cardiovasc Ther. 2020;18(12):905-917. doi:10.1080/14779072.2020.1837625.|||Franz CA, Frishman WH. Marijuana use and cardiovascular disease. Cardiol Rev. 2016;24(4):158-162. doi:10.1097/CRD.0000000000000103.|||Rezkalla SH, Sharma P, Kloner RA. Coronary no-flow and ventricular tachycardia associated with habitual marijuana use. Ann Emerg Med. 2003;42(3):365-369. doi:10.1016/s0196-0644(03)00426-8.|||Subramaniam VN, Menezes AR, DeSchutter A, Lavie CJ. The cardiovascular effects of marijuana: are the potential adverse effects worth the high? Mo Med. 2019;116(2):146-153.|||Rezkalla S, Stankowski R, Kloner RA. Cardiovascular effects of marijuana. J Cardiovasc Pharmacol Ther. 2016;21(5):452-455. doi:10.1177/1074248415627874.|||Latif Z, Garg N. The impact of marijuana on the cardiovascular system: a review of the most common cardiovascular events associated with marijuana use. J Clin Med. 2020;9(6):1925. doi:10.3390/jcm9061925.Published 2020 Jun 19.|||Thomas G, Kloner RA, Rezkalla S. Adverse cardiovascular, cerebrovascular, and peripheral vascular effects of marijuana inhalation: what cardiologists need to know. Am J Cardiol. 2014;113(1):187-190. doi:10.1016/j.amjcard.2013.09.042.|||Ghosh M, Naderi S. Cannabis and cardiovascular disease. Curr Atheroscler Rep. 2019;21(6):21. doi:10.1007/s11883-019-0783-9.|||Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103(23):2805-2809. doi:10.1161/01.cir.103.23.2805.|||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):465-470. doi:10.1016/j.ahj.2007.10.049.|||Ladha KS, Mistry N, Wijeysundera DN, et al. Recent cannabis use and myocardial infarction in young adults: a cross-sectional study. CMAJ. 2021;193(35):E1377-E1384.doi:10.1503/cmaj.202392.|||Gresnigt F, van den Brink LC, Hunault C, Franssen E, de Lange D, et al. Incidence of cardiovascular symptoms and adverse events following self-reported acute cannabis intoxication at the emergency department: a retrospective study. Emerg Med J. 2023;40(5):357-358. doi:10.1136/emermed-2022-212784.|||Singh SM, Koh M, Fang J, Ko DT. The risk of cardiovascular events on cannabis’ highest day. Can J Cardiol. 2019;35(11):1589-1591. doi:10.1016/j.cjca.2019.05.020.|||DeAngelis BN, Al’absi M. Regular cannabis use is associated with blunted affective, but not cardiovascular, stress responses. Addict Behav. 2020;107:106411. doi:10.1016/j.addbeh.2020.106411.|||Alhassan HA, Akunor H, Howard A, et al. Comparison of atherosclerotic cardiovascular risk factors and cardiometabolic profiles between current and never users of marijuana. Circ Cardiovasc Qual Outcomes. 2023;16(11):e009609.doi:10.1161/CIRCOUTCOMES.122.009609.|||Jouanjus E, Raymond V, Lapeyre-Mestre M, Wolff V. What is the current knowledge about the cardiovascular risk for users of cannabis-based products? A systematic review. Curr Atheroscler Rep. 2017;19(6):26. doi:10.1007/s11883-017-0663-0.|||Vallée A. Association between cannabis use and ten-year estimated atherosclerotic cardiovascular disease risk in a middle-aged population survey. Eur J Intern Med. 2023;111:69-76. doi:10.1016/j.ejim.2023.02.020.|||Goel A, McGuinness B, Jivraj NK, et al. Cannabis use disorder and perioperative outcomes in major elective surgeries: a retrospective cohort analysis. Anesthesiology. 2020;132(4):625-635.doi:10.1097/ALN.0000000000003067.|||Zongo A, Lee C, Dyck JRB, et al. Medical cannabis authorization and the risk of cardiovascular events: a longitudinal cohort study. BMC Cardiovasc Disord. 2021;21(1):426.doi:10.1186/s12872-021-02229-6.|||de La Harpe R, Schoeler T, Thorball CW, Thomas A, Kutalik Z, Vaucher J. Cannabis use and atherosclerotic cardiovascular disease: a Mendelian randomization study. BMC Cardiovasc Disord. 2023;23(1):611. doi:10.1186/s12872-023-03641-w.|||Kaufman TM, Fazio S, Shapiro MD. Brief commentary: marijuana and cardiovascular disease-what should we tell patients? Ann Intern Med. 2019;170(2):119-120. doi:10.7326/M18-3009.|||Aronow WS, Cassidy J. Effect of marihuana and placebo-marihuana smoking on angina pectoris. N Engl J Med. 1974;291(2):65-67. doi:10.1056/NEJM197407112910203.|||O’Keefe EL, Dhore-Patil A, Lavie CJ. Early-onset cardiovascular disease from cocaine, amphetamines, alcohol, and marijuana. Can J Cardiol. 2022;38(9):1342-1351. doi:10.1016/j.cjca.2022.06.027.|||Holt A, Nouhravesh N, Strange JE, et al. Cannabis for chronic pain: cardiovascular safety in a nationwide Danish study. Eur Heart J. 2024;45(6):475-484.doi:10.1093/eurheartj/ehad834.|||Adegbala O, Adejumo AC, Olakanmi O, et al. Relation of cannabis use and atrial fibrillation among patients hospitalized for heart failure. Am J Cardiol. 2018;122(1):129-134.doi:10.1016/j.amjcard.2018.03.015.|||Vallée A. Heavy lifetime cannabis use and mortality by sex. JAMA Netw Open. 2024;7(6):e2415227. doi:10.1001/jamanetworkopen.2024.15227.|||Sánchez Artiles AE, Awan A, Karl M, Santini A. Cardiovascular effects of cannabis (marijuana): a timely update. Phytother Res. 2019;33(5):1592-1594. doi:10.1002/ptr.6315.|||Gómez Ochoa SA. Stroke and cannabis use in patients with no cardiovascular risk factors: a systematic review of case reports. Neurologia (Engl Ed). 2021;36(3):222-228. doi:10.1016/j.nrl.2017.09.016.|||Barber PA, Pridmore HM, Krishnamurthy V, et al. Cannabis, ischemic stroke, and transient ischemic attack: a case-control study. Stroke. 2013;44(8):2327-2329.doi:10.1161/STROKEAHA.113.001562.|||Disdier P, Granel B, Serratrice J, et al. Cannabis arteritis revisited—ten new case reports. Angiology. 2001;52(1):1-5.doi:10.1177/000331970105200101.|||Palaniappan V, Sadhasivamohan A, Karthikeyan K. Raynaud’s phenomenon and splinter hemorrhage: an early telltale sign of cannabis arteritis. Int J Dermatol. 2022;61(12):e480-e483. doi:10.1111/ijd.16143.|||Shimol JB, Sheinberg O. Development of raynaud phenomenon following use of medical cannabis. J Clin Rheumatol. 2021;27(8S):S430-S431. doi:10.1097/RHU.0000000000001312.|||Lee C, Moll S. Migratory superficial thrombophlebitis in a cannabis smoker. Circulation. 2014;130(2):214-215. doi:10.1161/CIRCULATIONAHA.114.009935.|||Dakour-Aridi H, Arora M, Nejim B, Locham S, Malas MB. Association between drug use and in-hospital outcomes after infrainguinal bypass for peripheral arterial occlusive disease. Ann Vasc Surg. 2019;58:122-133.e4. doi:10.1016/j.avsg.2018.12.070.|||Narayanan M, Alnahhal KI, Lingutla R, et al. Outcomes of infrainguinal bypass in patients with cannabis vs opioid use disorder. Ann Vasc Surg. 2022;82:144-155. doi:10.1016/j.avsg.2021.10.069.|||Borja-Montes OF, Hanif H, Quazi MA, et al. Venous thromboembolism and cannabis consumption, outcomes among hospitalized patients in the United States: a nationwide analysis. Curr Probl Cardiol. 2024;49(1):102184.doi:10.1016/j.cpcardiol.2023.102184.|||Florimbio AR, Walton MA, Coughlin LN, Lin LA, Bonar EE. Perceived risk of harm for different methods of cannabis consumption: a brief report. Drug Alcohol Depend. 2023;251:110915. doi:10.1016/j.drugalcdep.2023.110915.|||Dai HD, Subramanian R, Mahroke A, Wang M. Prevalence and factors associated with vaping cannabidiol among US adolescents. JAMA Netw Open. 2023;6(8):e2329167. doi:10.1001/jamanetworkopen.2023.29167.|||Liu J, Nabavizadeh P, Rao P, et al. Impairment of endothelial function by aerosol from marijuana leaf vaporizers. J Am Heart Assoc. 2023;12(23):e032969.doi:10.1161/JAHA.123.032969.|||Boyd CJ, McCabe SE, Evans-Polce RJ, Veliz PT. Cannabis, vaping, and respiratory symptoms in a probability sample of U.S. youth. J Adolesc Health. 2021;69(1):149-152. doi:10.1016/j.jadohealth.2021.01.019.|||Bailey L. Vaping marijuana associated with more symptoms of lung damage than vaping or smoking nicotine. Michigan Medicine: University of Michigan; March 24, 2021. Available at: https://news.umich.edu/vaping-marijuana-associated-with-more-symptoms-of-lung-damage-than-vaping-or-smoking-nicotine/#:~:text=Adolescents%20who%20vape%20cannabis%20are,University%20of%20Michigan%20study%20suggests . Accessed 12 August, 2023.|||Werner AK, Koumans EH, Chatham-Stephens K, et al. Hospitalizations and deaths associated with EVALI. N Engl J Med. 2020;382(17):1589-1598.doi:10.1056/NEJMoa1915314.|||Blount BC, Karwowski MP, Shields PG, et al. Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. N Engl J Med. 2020;382(8):697-705.doi:10.1056/NEJMoa1916433.|||Page RL 2nd, Allen LA, Kloner RA, et al. Medical marijuana, recreational cannabis, and cardiovascular health: a scientific statement from the American heart association. Circulation. 2020;142(10):e131-e152.doi:10.1161/CIR.0000000000000883.|||Corroon J, Grant I, Allison MA, Bradley R. Associations between monthly cannabis use and myocardial infarction in middle-aged adults: NHANES 2009 to 2018. Am J Cardiol. 2023;204:226-233. doi:10.1016/j.amjcard.2023.07.065.