The Health Effects of Cannabis and Cannabinoids The Current State of Evidence and Recommendations for Research (2017) / Chapter Skim
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6 Cardiometabolic Risk
6 Cardiometabolic Risk
Pages 161-180
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From page 161... ...
. Both coronary heart disease and stroke are associated with aging, with nearly 93 percent of CHD deaths and 94 percent of stroke deaths occurring in individuals 55 years and older (Kochanek et al., 2016)
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From page 162... ...
The justification for examining cannabis use in relation to cardiometabolic conditions is that these conditions are among the leading causes of death; are highly prevalent in the United States; account for high levels of medical care utilization and cost; and are caused, in significant part, by modifiable lifestyle risk factors, including diet, physical activity, and cigarette smoking. The high prevalence of these conditions means that a behavior that is associated with a small degree of increased risk for heart disease, stroke, or diabetes can be associated with a high level of attributable risk, that is, the number of cases of disease that result from that behavior.
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From page 163... ...
did not make any conclusions or recommendations regarding cannabis use and acute myocardial infarctions. The acute cardiovascular effects of cannabis include increases in heart rate and supine blood pressure and postural hypotension (Beaconsfield et al., 1972; Benowitz and Jones, 1981)
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From page 164... ...
Both current and former cannabis use were unassociated with an increased risk of AMI. Study limitations included a reliance of self-report of cannabis use which may result in misclassification of this exposure; the lack of availability of longitudinal data on cannabis use; and the relatively young age (mean age 33 years)
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From page 165... ...
While the casecrossover design controls for confounding by traditional risk factors for cardiovascular disease, it does not control for interaction of these factors, and one cannot determine whether cannabis acts as a trigger in low-risk individuals or those who are nonsmokers of tobacco. Discussion of Findings While there are a number of reports of an association between cannabis use and AMI, only the two studies described above quantify risk, with the Sidney (2002)
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From page 166... ...
. The cardiovascular effects of cannabis that have been proposed as a possible mechanism in the etiology of stroke include orthostatic hypotension with secondary impairment of the autoregulation of cerebral blood flow, altered cerebral vasomotor function, supine hypertension and swings in blood pressure, cardioembolism with atrial fibrillation, other arrhythmias, vasculopathy, vasospasm, reversible cerebral vasoconstriction syndrome, and multifocal intracranial stenosis (Wolff et al., 2015)
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From page 167... ...
associated with current cannabis use and hospitalization for AIS was 1.17 (95% CI = 1.15–1.20) as calculated with multivariable logistic regression adjusted for age, gender, race, substance use, payer status, Charlson's comorbidity index, and other comorbid risk factors.
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From page 168... ...
Both current cannabis use and former cannabis use were not associated with increased risk of stroke. The study's limitations included its reliance on self-report of cannabis use, which may result in misclassification of this exposure; the lack of availability of longitudinal data on cannabis use; and the relatively young age of subjects (mean age 33 years)
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From page 169... ...
The limitations of this study include its cross-sectional design, the probable under-ascertainment of current cannabis use (2.2 percent is low for this age range) , the absence of data on duration of cannabis use, and the absence of analyses that are performed stratified by tobacco to determine the OR in non-tobacco use, given the high prevalence of this known risk factor for ischemic stroke.
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From page 170... ...
CONCLUSION 6-2 There is limited evidence of a statistical association between cannabis use and ischemic stroke or sub arachnoid hemorrhage. METABOLIC DYSREGULATION, METABOLIC SYNDROME, PREDIABETES, AND DIABETES MELLITUS Ranked as the seventh-leading cause of death in the United States, diabetes accounts for more than 76,000 deaths annually (Kochanek et al., 2016)
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From page 171... ...
. Because of the significance of diabetes as a highly prevalent disease, as a risk factor for cardiovascular diseases, and as a significant economic burden in our society, the question of whether cannabis use is associated with increased risk of diabetes is important.
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From page 172... ...
, physical activity, and the use of other illicit drugs. The CARDIA longitudinal analysis examined the association of self-reported cannabis use at the Year 7 follow-up exam to incident prediabetes (51 percent of participants)
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Discussion of Findings Overall, the articles reviewed by the committee were judged to be of good to fair quality for assessing the risk of metabolic dysregulation, metabolic syndrome, prediabetes, or diabetes mellitus associated with cannabis use. In their review of the evidence, the committee found that cannabis use had either an inverse association or no association with
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6-3(b) here is limited evidence of a statistical association T between cannabis use and increased risk of prediabetes.
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The committee also determined that there is limited evidence of an association between cannabis use and an increased risk of ischemic stroke or subarachnoid hemorrhage and also prediabetes and an association between cannabis and a decreased risk of metabolic dysregulation, metabolic syndrome, and diabetes. The limitations of the reviewed studies include a lack of information on different routes of cannabis administration (e.g, smoked, edible, etc.)
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From page 176... ...
There is no evidence to support or refute a statistical association between chronic effects of cannabis use and: • The increased risk of acute myocardial infarction (6-1b)
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From page 177... ...
2016. Heart disease and stroke statistics -- 2016 update: A report from the American Heart Association.
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From page 178... ...
2006. Marijuana use, diet, body mass index, and cardiovascular risk factors (from the CARDIA study)
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From page 179... ...
2015. Ischaemic strokes with reversible vasoconstriction and without thunderclap headache: A variant of the reversible cerebral vasoconstriction syndrome?
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