Stroke in young cannabis users (18–49 years): National trends in hospitalizations and outcomes

Alcover

Early Intervention Psych

et al. 2020

Aim: To explore the relationship between cannabis use and metabolic syndrome (MetS) among those who have experienced first episode psychosis (FEP).Methods: A retrospective analysis of 404 participants enrolled in the Recovery After Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) was conducted.Using multiple logistic regression, we investigated the correlation between cannabis use and rate of MetS at baseline and across time as well as the specific metabolic derangements among cannabis users and abstainers.Results: Although cannabis users had similar rates of MetS at baseline when compared with abstainers, those who used cannabis at any time during the study period tended to have lower triglycerides and elevated high-density lipoprotein (HDL). Cannabis users were less likely to develop MetS, relative to nonusers.Conclusions: Cannabis use may be associated with lower incidence of MetS in patients who have experienced FEP. Further research is indicated to develop these observations.

Section: Discussionsupporting

confidence: 92%

Cannabis use and metabolic syndrome among clients with first episode psychosis

Alcover

Early Intervention Psych

et al. 2020

“…Though our study did not show statistically significant acute myocardial infarction and cardiac arrest in CUD+, it did show higher odds for these events in CUD+ cohort without reaching a statistical significance. In our previous studies using the National Inpatient Sample and Behavioral Risk Factor Surveillance System (BRFSS) database from the CDC, we observed rising trends and positive associations of cannabis use with stroke events in young adults [ 32 , 33 ]. This is thought to be multifocal angiopathy in young individuals [ 34 ] or a cannabis-related consequence of arterial obstruction from a post-myocardial infarction left ventricular thrombus [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Hypertensive Crisis-Related Hospitalizations and Subsequent Major Adverse Cardiac Events in Young Adults with Cannabis Use Disorder: A Nationwide Analysis

et al. 2022

Background and Objectives: With the growing recreational cannabis use and recent reports linking it to hypertension, we sought to determine the risk of hypertensive crisis (HC) hospitalizations and major adverse cardiac and cerebrovascular events (MACCE) in young adults with cannabis use disorder (CUD+). Material and Methods: Young adult hospitalizations (18–44 years) with HC and CUD+ were identified from National Inpatient Sample (October 2015–December 2017). Primary outcomes included prevalence and odds of HC with CUD. Co-primary (in-hospital MACCE) and secondary outcomes (resource utilization) were compared between propensity-matched CUD+ and CUD- cohorts in HC admissions. Results: Young CUD+ had higher prevalence of HC (0.7%, n = 4675) than CUD- (0.5%, n = 92,755), with higher odds when adjusted for patient/hospital-characteristics, comorbidities, alcohol and tobacco use disorder, cocaine and stimulant use (aOR 1.15, 95%CI:1.06–1.24, p = 0.001). CUD+ had significantly increased adjusted odds of HC (for sociodemographic, hospital-level characteristics, comorbidities, tobacco use disorder, and alcohol abuse) (aOR 1.17, 95%CI:1.01–1.36, p = 0.034) among young with benign hypertension, but failed to reach significance when additionally adjusted for cocaine/stimulant use (aOR 1.12, p = 0.154). Propensity-matched CUD+ cohort (n = 4440, median age 36 years, 64.2% male, 64.4% blacks) showed higher rates of substance abuse, depression, psychosis, previous myocardial infarction, valvular heart disease, chronic pulmonary disease, pulmonary circulation disease, and liver disease. CUD+ had higher odds of all-cause mortality (aOR 5.74, 95%CI:2.55–12.91, p < 0.001), arrhythmia (aOR 1.73, 95%CI:1.38–2.17, p < 0.001) and stroke (aOR 1.46, 95%CI:1.02–2.10, p = 0.040). CUD+ cohort had fewer routine discharges with comparable in-hospital stay and cost. Conclusions: Young CUD+ cohort had higher rate and odds of HC admissions than CUD-, with prevalent disparities and higher subsequent risk of all-cause mortality, arrhythmia and stroke.

Front. Cardiovasc. Med.

“…However, the observed association may be related to concomitant smoking or the use of other unknown toxins in synthetic marijuana (302,303). Cannabis exposure may be related to cerebral vasoconstriction, cardioembolism due to cardiac ischemia and arrhythmia, and thrombophilia (304,305). Cannabis may rarely cause hemorrhagic stroke due to a sudden rise in blood pressure (305).…”

Section: Medications With Potential Benefit For Covid-19 Therapymentioning

confidence: 99%

Stroke in SARS-CoV-2 Infection: A Pictorial Overview of the Pathoetiology

Neshin

Shahjouei

Koza

et al. 2021

Since the early days of the pandemic, there have been several reports of cerebrovascular complications during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Numerous studies proposed a role for SARS-CoV-2 in igniting stroke. In this review, we focused on the pathoetiology of stroke among the infected patients. We pictured the results of the SARS-CoV-2 invasion to the central nervous system (CNS) via neuronal and hematogenous routes, in addition to viral infection in peripheral tissues with extensive crosstalk with the CNS. SARS-CoV-2 infection results in pro-inflammatory cytokine and chemokine release and activation of the immune system, COVID-19-associated coagulopathy, endotheliitis and vasculitis, hypoxia, imbalance in the renin-angiotensin system, and cardiovascular complications that all may lead to the incidence of stroke. Critically ill patients, those with pre-existing comorbidities and patients taking certain medications, such as drugs with elevated risk for arrhythmia or thrombophilia, are more susceptible to a stroke after SARS-CoV-2 infection. By providing a pictorial narrative review, we illustrated these associations in detail to broaden the scope of our understanding of stroke in SARS-CoV-2-infected patients. We also discussed the role of antiplatelets and anticoagulants for stroke prevention and the need for a personalized approach among patients with SARS-CoV-2 infection.