Cannabinoids and Myocardial Ischemia: Novel insights, Updated Mechanisms, and Implications for Myocardial Infarction

Abstract

: Cannabis is the most widely trafficked and abused illicit drug due to its calming psychoactive properties. It has been increasingly recognized as having potential health benefits and relatively less adverse health effects as compared to other illicit drugs; however, growing evidence clearly indicates that cannabis is associated with considerable adverse cardiovascular events. Recent studies have linked cannabis use to myocardial infarction (MI); yet, very little is known about the underlying mechanisms. A MI is a cardiovascular disease characterized by a mismatch in the oxygen supply and demand of the heart, resulting in ischemia and subsequent necrosis of the myocardium. Since cannabis is increasingly being considered a risk factor for MI, there is a growing need for better appreciating its potential health benefits and consequences. Here, we discuss the cellular mechanisms of cannabis that lead to an increased risk of MI. We provide a thorough and critical analysis of cannabinoids’ actions, which include modulation of adipocyte biology, regional fat distribution, and atherosclerosis, as well as precipitation of hemodynamic stressors relevant in the setting of a MI. By critically dissecting the modulation of signaling pathways in multiple cell types, this paper highlights the mechanisms through which cannabis may trigger life-threatening cardiovascular events. This then provides a framework for future pharmacological studies which can identify targets or develop drugs that modulate cannabis’ effects on the cardiovascular system as well as other organ systems. Cannabis’ impact on the autonomic outflow, vascular smooth muscle cells, myocardium, cortisol levels and other hemodynamic changes are also mechanistically reviewed.

Potential perioperative cardiovascular outcomes in cannabis/cannabinoid users. A call for caution

“…However, activation of CB2_R has the opposite effect, inhibiting endothelial cell adhesion and vascular smooth muscle cell migration ( 98 ). Aronow and Cassidy performed a study to evaluate the effect of marijuana on cardiovascular function and exercise-induced angina in 10 men with underlying severe coronary disease, none of whom had previously consumed marijuana.…”

Paroxysmal Sustained Ventricular Tachycardia with Cardiac Arrest and Myocardial Infarction in 29-Year-Old Man Addicted to Medical Marijuana—It Never Rains but It Pours

“…Another potentially life-threatening complication of marijuana is myocardial infarction. The mechanisms leading to acute myocardial ischemia cover artery vasospasm and dissection, vasculitis, increased platelet aggregation and coronary artery thrombosis, autonomic nervous system imbalance, oxidative stress, endothelial injury and inflammation secondary to impurities and even hypertensive urgency from abrupt withdrawal [ 22 , 23 , 24 ]. Clinical manifestation varies from angina to cardiac arrest.…”