Marijuana: An Underappreciated Risk Factor for Acute Type A Aortic Dissection?

Abstract

Background: Stimulants such as cocaine and amphetamines are well-established risk factors for acute aortic dissection. Despite the fact that marijuana is the most commonly used illicit drug in the United States, its relationship to acute aortic syndromes has not been well studied. Methods: A comprehensive retrospective review was undertaken of all consecutive patients who presented with acute Stanford type A aortic dissection from January 2017 to December 2019. Of 152 patients identified, 51 (33.6%) underwent comprehensive urine toxicology screening at clinical presentation. The characteristics and outcomes of the patients with urine results positive for tetrahydrocannabinol (THC) (n = 9, 17.6%) were compared with the 42 patients who had no evidence of recent marijuana consumption. Results: Of the 51 dissection patients who underwent broad-spectrum urine toxicology screening upon presentation, 9 (17.6%) returned positive results for THC, a proportion higher than would be expected for the general population. All THC patients were male; 3 concurrently tested positive for cocaine, and 3 others had evidence of recent amphetamine use. The THC patients were significantly younger than the non-THC patients (mean ± standard deviation age 48 ± 11.3 versus 61.4 ± 12.3 years, respectively, P = .004). A greater proportion of the THC cohort had a known diagnosis of aortic aneurysm before the dissection (44.4% versus 4.8%, P = .006). All patients underwent expeditious surgical repair. Thirty-day mortality for the entire cohort of 51 patients was 19.6% (10 deaths); for the THC group, it was 11.1% (1 death). There was no difference in the incidence of major postoperative complications between the 2 groups. Conclusion: Marijuana is the third most commonly used substance in the United States, after alcohol and tobacco. Although marijuana use is understudied, our results suggest that marijuana may be a contributing risk factor for acute type A aortic dissection, particularly in patients with other predisposing risk factors. Given the recent national trend to legalize marijuana, with the concomitant potential for exponential increases in its consumption, we suggest that the diagnosis of aortic dissection be considered earlier in any younger patient who presents with suggestive symptoms, especially if there is a history of recent marijuana use.

Cannabis and adverse cardiovascular events: A systematic review and meta-analysis of observational studies

“…Of the 20 included studies, a total of 183,410,651 patients were enrolled with the number of participants in each study ranging from 51 to 118,659,619 patients. [10] , [11] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] The median age was 42.4 years old (IQR: 37.4, 50.0). The proportion of males was 23.7%.…”

“…Thirteen studies with a total of 172,285,631 patients reported stroke, which occurred in 248,563 patients (0.14%) [10] , [24] , [25] , [27] , [28] , [29] , [33] , [34] , [35] , [36] , [37] , [38] , [40] . The pooled OR and rates of stroke were shown in [ Fig.…”

“…Twenty studies with a total of 183,410,651 patients reported composite adverse CV events, which occurred in 313,703 patients (0.17%) [10] , [11] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] . The pooled OR and rates of composite adverse CV events were shown in [ Fig.…”

“…Thus, we used the random-effect model in our meta-analysis for this reason. Third, most of the included studies are cross-sectional and retrospective studies which include participants from the pre-existing cohort, national registry, and survey [10] , [11] , [24] , [26] , [27] , [28] , [29] , [30] , [31] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] . Hence, the data recorded in these studies were not pre-specified for cannabis use and could lead to information bias.…”

Aortic dissection: global epidemiology

“…Marijuana taken with other stimulants can increase the heart rate, blood pressure, and systemic sympathetic tone [119] . Nevertheless, Sarmiento et al did not observe short-term mortality differences in groups with or without marijuana abuse [120] . Re-intervention, long-term poor physical condition, and a high rate of complications may affect marijuana users.…”