New Review Urges Screening for Cannabis Use in Heart Patients

A new review found >2 million US adults with established cardiovascular disease (CVD) reported past or present use of marijuana, prompting authors to recommend screening for cannabis use in these patients.

The review, led by researchers at Brigham and Women’s Health, was published in the Journal of the American College of Cardiology.

As more states have legalized marijuana for recreational and/or medicinal use, researchers identified an “epidemiological shift” where, for the first time, US marijuana use is exceeding cigarette use.

“This was eye-opening for us…More patients are curbing their cigarette smoking, and we’re seeing big improvements in cardiovascular health for those who quit. In contrast, we’re seeing an accelerating use of marijuana,” said corresponding author and cardiologist Muthiah Vaduganathan, MD, MPH, Brigham and Women’s Hospital, Boston, Massachusetts in a hospital press release. “We now need to turn our attention and public health resources toward understanding the safety profile of its use.”

Using data from the 2015-2016 National Health and Nutrition Examination Survey, Vaduganathan and colleagues estimated nearly 2 million (2.3%) of the >89 million adults who reported marijuana use had CVD.

More states have passed marijuana-related legislature since then, so researchers did note this number may have increased. 

Researchers also noted the unpredictable interactions marijuana can have with commonly prescribed medications for CVD, furthering the need for more research to properly counsel patients.

“Notably, many of our cardiology patients are on medications that can interact with marijuana in unpredictable ways depending on the formulation,” said lead author Ersilia M. DeFilippis, MD, Columbia University Irving Medical Center, New York, New York in the same press release.

Studies have shown an association between cannabis and a range of cardiovascular risks including stroke and arrhythmia, but rigorous studies are lacking due to marijuana’s schedule I drug classification.

Until more information is known, how can physicians answer patient questions regarding marijuana safety? Review authors offered their current approach for guidance.

“In the clinic, patients often ask us about the safety of marijuana use and we’re pressed to offer the best scientific evidence,” said Vaduganathan. “Our current approach is that patients who are at high risk of cardiovascular events should be counseled to avoid or at least minimize marijuana use, and that rigorous scientific research should be conducted to further inform recommendations for patient care.”