Cannabis Use and the Risk of Cardiovascular Diseases: A Mendelian Randomization Study

Abstract

Several observational studies have shown that cannabis use has negative effects on the cardiovascular system, but the causality of this relationship has not been confirmed. The aim of the current study was to estimate the effects of genetically determined cannabis use on risk of cardiovascular diseases. Ten single-nucleotide polymorphisms related to cannabis use were employed as instruments to estimate the association between genetically determined cannabis use and risk of cardiovascular diseases using a two-sample Mendelian randomization (MR) method. Summary statistics data on exposure and outcomes were obtained from different genome-wide association meta-analysis studies. The results of this MR analysis showed no causal effects of cannabis use on the risk of several common cardiovascular diseases, including coronary artery disease, myocardial infarction, stroke and ischemic stroke subtypes, atrial fibrillation (AF), and heart failure. Various sensitivity analyses yielded similar results, and no heterogeneity and directional pleiotropy were observed. After adjusting for tobacco use and body mass index, multivariable MR analysis suggested a causal effect of cannabis use on small vessel stroke (SVS) [odds ratio (OR) 1.17; 95% CI 1.02–1.35; p = 0.03] and AF (OR 1.06; 95% CI 1.01–1.10; p = 0.01), respectively. This two-sample MR study did not demonstrate a causal effect of genetic predisposition to cannabis use on several common cardiovascular outcomes. After adjusting for tobacco use and body mass index, the multivariable MR analysis suggested a detrimental effect of cannabis use on the risk of SVS and AF, respectively.

Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

“…However, in a much larger study of over 27,000 records, the active cannabinoid user had increased odds of experiencing a myocardial infarction [373]. This finding is aligned with a prior observation of increased risk of cardiac events in cannabinoid users in general [129,196,206,232,361,362].…”

“…A similar excessive risk was seen in the case of a cardiovascular accident [205]. However, this is not a uniform finding [206]. It seems well established that an increased risk of a cardiovascular event in the wake of cannabinoid use is present even after singular exposure [207][208][209][210].…”

“…Furthermore, carboxyhemoglobinemia may be another contributing factor [82,170]. Finally, some suggested that the cardiotoxic effect of marijuana may be independent of classical culprits of the acute coronary syndrome [206].…”

“…With increased consumption of cannabinoids worldwide, it is important to consider potential additives, as the patient may not be aware of them. Acute cannabinoid use seems to be related to increased blood pressure, tachycardia, and increased or decreased cardiac contractility [128,129,196,[198][199][200]202,206,207,232,[362][363][364]. The limitation of these data is that the perioperative intake of cannabinoids is difficult to standardize even within the same patient.…”

Efectos adversos del consumo de marihuana en el sistema cardiovascular

“…(Auger et al, 2020) En un análisis de cohorte retrospectivo realizado por Chami et al se identificó a 292 770 pacientes con antecedentes de abuso de cannabis en donde se confirmó que el abuso de cannabis se asoció significativamente con incidentes de IM. (Zhao et al, 2021) Otros mecanismos potenciales incluyen disfunción endotelial mediada por CB1 y vasoespasmos que conducen a la oclusión arterial total que resulta en isquemia. La disfunción endotelial inducida por THC es causada por el estrés oxidativo y la producción reducida de óxido nítrico.…”