Marijuana use and long-term mortality among survivors of acute myocardial infarction

Abstract

Background Smoking marijuana has been reported to increase risk of myocardial infarction (MI) immediately after use, but less is known about the long-term impact of marijuana use among patients with established coronary disease. Methods The Determinants of MI Onset Study (MIOS) is a multicenter inception cohort study of MI patients enrolled in 1989–1996 and followed for mortality using the National Death Index. In an initial analysis of 1935 MI survivors followed for a median of 3.8 years, we found an increased mortality rate among marijuana users. The current paper includes 3886 MIOS patients followed for up to 18 years. We used Cox proportional hazards models to calculate the hazard ratio and 95% confidence interval for the association between marijuana use and mortality and a propensity score matched analysis to further control confounding. Results Over up to 18 years of follow-up, 519 patients died, including 22 of the 109 reporting marijuana use in the year prior to their MI. There was no statistically significant association between marijuana use and mortality. Compared to non-users, the mortality rate was 29% higher (95% confidence interval 0.81 to 2.05, p=0.28) among those reporting any marijuana use. Conclusions Habitual marijuana use among patients presenting with acute MI was associated with an apparent increased mortality rate over the following 18 years that did not reach nominal statistical significance. Larger studies with repeated measures of marijuana use are needed to definitively establish whether there are adverse cardiovascular consequences of smoking marijuana among patients with established coronary heart disease.

Cannabinoids, the Heart of the Matter

“…Nonetheless, there is a possible increased risk of mortality for patients who have already had a past myocardial infarction compared with marijuana smokers that did not 87. Some early studies concluded that marijuana users do not have a significantly increased risk of stroke and heart failure later showed that those risks were significant upon longer follow up with multivariable analysis showing greater relative risk of myocardial infarction the younger group 3, 88. The CARDIA cohort study which spanned 25 years showed no association of marijuana use with CVD or atherosclerosis risk 5, 6.…”

“…The CARDIA cohort study which spanned 25 years showed no association of marijuana use with CVD or atherosclerosis risk 5, 6. Furthermore, many studies have been inconclusive and suggest that further research on a larger scale with repeated measures are needed 3, 4, 7. Despite the possible CVD risks associated with marijuana use, there is rational potential for modulation of the ECS using exogenous cannabinoids derived from plants or synthetic sources, as single drugs or complex mixtures, for treatment of disease in the CVD space.…”

“…This makes understanding the long‐term effects of cannabis, whether harmful or beneficial, imperative. While acute adverse effects (impairment of memory, coordination and judgement) are widely accepted, most studies on long‐term use and effects have been inconclusive 3, 4, 5, 6, 7. These inconclusive results could possibly be due to the barriers in conducting cannabis research such as: access to the quality and quantity of cannabis needed for research as well as cannabis being classified as a Schedule 1 substance 7.…”

Características, manejo y evolución intrahospitalaria de usuarios de drogas ilícitas con infarto agudo del miocardio

“…En nuestro país se estiman prevalencias de 7,1% y 0,9% para el consumo de cannabis y cocaína respectivamente entre los 12 y los 25 años 2 , desconociéndose la prevalencia de consumo de estas sustancias en la población general. El consumo agudo o crónico de ambas DI ha sido descrito como factor de riesgo de infarto agudo del miocardio (IAM), miocardiopatías y arritmias cardiacas, describiéndose diversos mecanismos fisiopatológicos involucrados en la injuria miocárdica por drogas [3][4][5][6] . Las recomendaciones del manejo del IAM en estos pacientes se basan fundamentalmente en opiniones de expertos 5 , siendo escasas las experiencias sobre el manejo de esta subpoblación y su evolución posterior.…”

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, rAmÓn corbAlán 3,6 . GruPo de estudio multicéntrico del infArto (Gemi) Characteristics, management, and outcomes of illicit drug consumers with acute myocardial infarction (86.3% and 42.5% respectively, p < 0.01).

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