Marijuana use and coronary artery disease in young adults

Jeremy R. Burt, Ali M. Agha, Basel Yacoub, Aryan Zahergivar, Julie Pepe

PLoS ONE, 2020, 15, (1), e0228326, 1-8.

Doi : 10.1371/journal.pone.0228326

 

Abstract

Background

Marijuana is the most popular drug of abuse in the United States. The association between its use and coronary artery disease has not yet been fully elucidated. This study aims to determine the frequency of coronary artery disease among young to middle aged adults presenting with chest pain who currently use marijuana as compared to nonusers.

Methods

In this retrospective study, 1,420 patients with chest pain or angina equivalent were studied. Only men between 18 and 40 years and women between 18 and 50 years of age without history of cardiac disease were included. All patients were queried about current or prior cannabis use and underwent coronary CT angiography. Each coronary artery on coronary CT angiography was assessed based on the CAD-RADS reporting system.

Results

A total of 146 (10.3%) out of 1,420 patients with chest pain were identified as marijuana users. Only 6.8% of the 146 marijuana users had evidence of coronary artery disease on coronary CT angiography. In comparison, the rate was 15.0% among the 1,274 marijuana nonusers (p = 0.008). After accounting for other cardiac risk factors in a multivariate analysis, the negative association between marijuana use and coronary artery disease on coronary CT angiography diminished (p = 0.12, 95% CI 0.299–1.15). A majority of marijuana users were younger than nonusers and had a lower frequency of hypertension and diabetes than nonusers. There was no statistical difference in lipid panel values between the two groups. Only 2 out of 10 marijuana users with coronary artery disease on coronary CT angiography had hemodynamically significant stenosis.

Conclusion

Among younger patients being evaluated for chest pain, self-reported cannabis use conferred no additional risk of coronary artery disease as detected on coronary CT angiography.

Introduction

Marijuana is the most popular drug of abuse in the United States and the prevalence of its use has been on the rise among both adolescents and adults [1]. Inhalation or ingestion of cannabis leads to a myriad of physiological changes, most commonly tachycardia modulated by increased sympathetic activity. It may also cause increased systolic and diastolic blood pressures in supine individuals, orthostatic hypotension and orthostatic pre-syncope. A decreased left ventricular ejection fraction, end diastolic volume and stroke volume have also been observed in subjects using marijuana. Cardiac output remains unaffected as stroke volume and heart rate change in opposite directions [2].

Smoking of marijuana has been reported as a trigger of acute myocardial infarction (MI) in 3.2% of 3,882 patients interviewed by Mittleman et al. Their study also reported that the risk of onset of MI is elevated 4.8 times in the first hour after marijuana use and rapidly decreases thereafter [3], which may be explained by marijuana induced coronary vasospasm [4]. Despite similar findings reported elsewhere [2, 5], evidence on the association of marijuana with the development of coronary artery atherosclerotic disease has not yet been fully elucidated. A systematic review of 24 articles by Ravi et al. assessed the effect of marijuana on cardiovascular risk factors and outcomes and reported that evidence in published literature is insufficient to make any conclusions [6]. This lack of knowledge is alarming as CAD is a major cause of morbidity and mortality in developed countries. Currently, the well-established risk factors of CAD include diabetes, hypertension, high total cholesterol, low HDL level, smoking tobacco
and advanced age [7].

This retrospective study aims to determine the frequency of CAD among young adults presenting with chest pain who currently use marijuana as compared to nonusers. Only young adults were assessed in this study because of the high prevalence of marijuana use among this subpopulation [8].

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pone.0228326