Effect of Marihuana and Placebo-Marihuana Smoking on Angina Pectoris

Aronow, Wilbert S.; Cassidy, John

doi:10.1056/nejm197407112910203

Cited by 160 publications

(115 citation statements)

References 12 publications

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“…Similar cases of MI in patients with moderate tabagism and chronic use of cannabis are reported in the literature [17]. Cannabis has been shown to trigger the occurrence of angina pectoris symptoms after physical effort among patients with a history of coronary disease or stable angina pectoris, earlier than the use of tobacco [18]. In another study, risk of MI was almost 5-fold greater in patients who had acknowledged cannabis use (4.8, 95% CI 2.4, 9.5) [19].…”

Section: Discussionsupporting

confidence: 57%

Cannabis‐related hospitalizations: unexpected serious events identified through hospital databases

Jouanjus

Leymarie

Tubery

et al. 2011

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• The general knowledge on cannabis toxicity has improved, but quantitative data are still lacking.• Little is known about the somatic complications associated with cannabis exposure. Available data rest upon case reports and only a few studies have been conducted in this field.• Psychiatric disorders related to cannabis exposure are somehow still controversial.WHAT THIS STUDY ADDS• Quantitative estimates are key to comprehending the risks of medical outcomes in cannabis users, in particular the somatic complications of use. Our study suggests that cannabis use has to be linked to serious health defects, particularly neurological and cardiovascular disorders.• Our study gives estimates of the annual incidence of cannabis‐related hospitalizations.• Our study should contribute to enhancing the medical management of cannabis using patients.AIMS Cannabis is the most prevalent illicit drug used worldwide and can be responsible for serious health defects in users. However, the risk related to cannabis consumption is not well established. The present study aimed to assess cannabis‐related adverse events leading to hospitalization, and to estimate the corresponding annual risk for consumers.METHODS Participants were patients admitted to the public hospitals in the Toulouse area (France) between January 2004 and December 2007 in relation to the use of cannabis. Reasons for admission and other occurring events were identified through hospital discharge summaries. We described all observed adverse events (AEs) and estimated their regional incidence on the basis of cannabis consumption data.RESULTS We included 200 patients, and identified a total of 619 adverse events (AEs), one of which was lethal. Psychiatric disorders involved 57.7% of patients and accounted for 18.2% of AEs. Most frequent outcomes were central and peripheral nervous system disorders (15.8% of AEs), acute intoxication (12.1%), respiratory system disorders (11.1%) and cardiovascular disorders (9.5%). We estimated that in 2007 the incidence of cannabis‐related AEs in the Midi‐Pyrenees region ranged from 1.2 per 1000 regular cannabis users (95% confidence interval (CI) 0.7, 1.6) to 3.2 (95% CI 2.5, 3.9).CONCLUSIONS Cannabis use is associated with complications, considered to be serious since they lead to hospitalization. Beyond the well‐known and widely investigated psychiatric events, serious cerebro and cardiovascular complications have been identified. These findings contribute to improve the knowledge of cannabis‐related adverse events.

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Section: Discussionsupporting

confidence: 57%

Cannabis‐related hospitalizations: unexpected serious events identified through hospital databases

Jouanjus

Leymarie

Tubery

et al. 2011

Brit J Clinical Pharma

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“…For example, smoking marijuana is associated with a dose-dependent increase in heart rate. [2][3][4][5][6][7][8][9][10] Although there is much interindividual variability, typical increases in heart rate associated with a single marijuana cigarette range from 20% to 100%, with the peak in heart rate occurring 10 to 30 minutes after beginning to smoke. 2,4,6 -8 In addition, most subjects experience an increase in blood pressure, particularly when supine.…”

Section: Mittleman Et Al Marijuana and Acute Myocardial Infarctionmentioning

confidence: 99%

“…2,4,6 -8 In addition, most subjects experience an increase in blood pressure, particularly when supine. 3,6,7,9 Postural hypotension after smoking marijuana is not uncommon. 5,9,27 Tolerance to the hemodynamic effects of marijuana can occur with frequent repeated use.…”

Section: Mittleman Et Al Marijuana and Acute Myocardial Infarctionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10] Blood pressure is typically increased in the supine position, 3,6,7,9 and postural hypotension, which is often symptomatic, is common. Overall, there is a net increase in myocardial oxygen demand with a decrease in oxygen supply, which is due in part to an increase in carboxyhemoglobin 3 ; this results in a lower anginal threshold in patients with chronic stable angina. 3,11 Furthermore, there are several reports of myocardial infarction occurring in close proximity to marijuana use in otherwise low-risk individuals.…”

mentioning

confidence: 99%

“…Overall, there is a net increase in myocardial oxygen demand with a decrease in oxygen supply, which is due in part to an increase in carboxyhemoglobin 3 ; this results in a lower anginal threshold in patients with chronic stable angina. 3,11 Furthermore, there are several reports of myocardial infarction occurring in close proximity to marijuana use in otherwise low-risk individuals. [12][13][14] An Institute of Medicine report on marijuana and medicine released in 1999 noted that although the cardiovascular effects of marijuana do not seem to pose a health problem for healthy young users, they may present a serious problem for older subjects.…”

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confidence: 99%

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Triggering Myocardial Infarction by Marijuana

et al. 2001

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Background-Marijuana use in the age group prone to coronary artery disease is higher than it was in the past. Smoking marijuana is known to have hemodynamic consequences, including a dose-dependent increase in heart rate, supine hypertension, and postural hypotension; however, whether it can trigger the onset of myocardial infarction is unknown. Methods and Results-In the Determinants of Myocardial Infarction Onset Study, we interviewed 3882 patients (1258 women) with acute myocardial infarction an average of 4 days after infarction onset. We used the case-crossover study design to compare the reported use of marijuana in the hour preceding symptoms of myocardial infarction onset to its expected frequency using self-matched control data. Of the 3882 patients, 124 (3.2%) reported smoking marijuana in the prior year, 37 within 24 hours and 9 within 1 hour of myocardial infarction symptoms. Compared with nonusers, marijuana users were more likely to be men (94% versus 67%, PϽ0.001), current cigarette smokers (68% versus 32%, PϽ0.001), and obese (43% versus 32%, Pϭ0.008). They were less likely to have a history of angina (12% versus 25%, PϽ0.001) or hypertension (30% versus 44%, Pϭ0.002). The risk of myocardial infarction onset was elevated 4.8 times over baseline (95% confidence interval, 2.4 to 9.5) in the 60 minutes after marijuana use. The elevated risk rapidly decreased thereafter. Conclusions-Smoking marijuana is a rare trigger of acute myocardial infarction. Understanding the mechanism through which marijuana causes infarction may provide insight into the triggering of myocardial infarction by this and other, more common stressors.

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The effect of marihuana intoxication on blood pressure

1978

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Forty-eight experienced marihuana smokers were assigned to one of four groups: coltsfoot, placebo, low dose marihuana and high dose marihuana. While both marihuana groups showed significant increases in subjective ratings of intoxication and pulse rate, blood pressure readings were unaffected or showed a modest decrease. This latter finding is discrepant with previous studies and is explained in terms of a drug X person interaction present in those studies.

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Effect of Marihuana and Placebo-Marihuana Smoking on Angina Pectoris

Cited by 160 publications

References 12 publications

Cannabis‐related hospitalizations: unexpected serious events identified through hospital databases

Cannabis‐related hospitalizations: unexpected serious events identified through hospital databases

Triggering Myocardial Infarction by Marijuana

The effect of marihuana intoxication on blood pressure

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