Effect of marijuana use on cardiovascular and cerebrovascular mortality

Eku Oben, Mercer University College of Pharmacy

 

Marijuana was shown to increase heart rate and blood pressure by 20 to 100%. [1] However, it can cause hypotension in high doses or when taken orally. [2] Users 14-18 years old with heavy marijuana use (~56 g/month) performed worse on flexible thinking tests compared to controls with limited marijuana use (<7 g/month). When comparing marijuana users to non-marijuana users, the adjusted hazards ratio (HR) for hypertension mortality was 3.42 (95% CI: 1.2- 9.79) and for each year of marijuana use, was 1.04 (95% CI: 1- 1.07). The adjusted HR for heart disease mortality between the two groups was 1.09 (95% CI: 0.63 -1.88); and 1 (95% CI: 0.98-1.02) for each year of marijuana use. [3]

 

Design A mortality follow-up survey; N= 1213
Objective To determine whether recreational marijuana is associated with increased cardiovascular mortality
Study Group Marijuana users (n= 686); non-marijuana users (n= 527)
Methods A cox proportional hazards regression analyses was used to estimate hazard ratios for hypertension, heart disease, and cerebrovascular mortality due to marijuana use.
Duration 2005 – 2011
Primary Outcome Measure Increased cardiovascular mortalities
Baseline Characteristics
Participants

 

Variables Sample % Total mortality sample HBP % HD % CBV %
Age ≤25 years 226 18.6 63 9.5 22.2 11.1
Age ≥25 987 81.4 269 12.6 23 6.3
Total 1213 100 332 12.1 22.9 7.2
Male 550 45.3 168 8.3 23.2 4.8
Female 663 54.7 164 15.9 22.6 9.8
Non- Hispanic whites 579 47.7 162 14.8 26.5 7.4
Non- Hispanic Blacks 286 23.6 76 7.9 19.7 10.5
Mexican Americans 246 20.3 63 7.9 22.2 3.2
Other Hispanics 45 3.7 11 27.3 18.2 0
Other Race 57 4.7 20 10 10 10
<9th grade 89 7.3 20 15 30 5
9th -11th grade 166 13.7 43 7 20.9 9.3
High school graduate 277 22.9 76 7.6 21.1 7.9
Some college/associate degree 397 32.5 112 15.2 19.6 8
≥College graduate 286 23.6 81 13.6 28.4 4.9
Marijuana users 686 56.5 204 13.7 22.5 7.4
Non-marijuana users 527 43.5 138 9.4 23.4 7
Current cigarette smokers 296 24.4 89 10.1 15.7 9
Past-cigarette smokers 248 20.4 74 14.9 27 9.5
Non-cigarette smokers 669 55.2 169 11.8 24.8 5.3
Alcohol use 190 17.7 55 10.9 29.1 7.3
No alcohol use 882 82.3 243 11.1 22.6 6.2
Results Unadjusted and adjusted analysis showing hazard ratios for hypertension mortality among (a) marijuana users and (b) each year of marijuana use.

Substance use and demographic factors Unadjusted hazards ratio (95% confidence interval) Adjusted hazards ratio (95% confidence interval)
a).
Marijuana user 1.86 (0.95-3.66) 3.42 (1.20-9.79)
Current smoker 1.06 (0.48-2.33) 1.06 (0.4-2.77)
Former smoker 1.56 (0.75-3.25) 1.33 (0.57-3.1)
Alcohol user 1.03 (0.43-2.5) 0.95 (0.37-2.45)
Body mass index 1.03 (1-1.08) 1.05 (1.01-1.1)
Age >25 years 1.29 (0.54-3.08) 1.25 (0.42-3.67)
Education 1.19 (0.9-1.57) 1 (0.7-1.43)
Male 0.67 (0.35-1.29) 0.72 (0.35-1.49)
Blacks 0.51 (0.21-1.24) 0.42 (0.14-1.27)
Mexican Americans 0.49 (0.19- 1.28) 0.91 (0.28-2.94)
Other Hispanics 1.58 (0.48-5.25) 2.51 (0.54-11.63)
Other race 0.92 (0.22-3.89) 1.23 (0.29-5.35)
Have health insurance 2.66 (1.04-6.79) 2.24 (0.75-6.72)
Diagnosed with hypertension 0.86 (0.38-1.93) 0.81 (0.32-2.06)
Diagnosed with a CVD 2.18 (1-1.05) 1.94 (0.42-8.97)
b).
Each year of marijuana use 1.03 (0.48-2.33) 1.14 (0.43-3.01)
Current smoker 1.06 (0.48-2.33) 1.14 (0.43-3.01)
Former smoker 4.56 (0.75-3.25) 1.35 (0.57-3.2)
Adverse Effects Common: none reported
Serious: none reported
Percentage that discontinued due to adverse events: N/A
Study Author Conclusions Using marijuana may increase the risk for hypertension mortality and cardiovascular adverse effects.

 

The data from this study was representative of the overall population. However, it was self-reported by the participants, which may call to question its validity and seen as a limitation to the study. In addition, only 72.5% of participants were presumed to be alive during the time of the study, which could be another limitation of the study. Findings of this study support the evidence that marijuana use increases the risk of cardiovascular effects and hypertension mortality.

 

References

[1] Jacobus J, Tapert SF. Effects of Cannabis on the Adolescent Brain. Curr Pharm Des. 2014;20(13):2186-2193.

[2] Jones RT. Cardiovascular system effects of marijuana. J Clin Pharmacol. 2002;42(11):58S-63S.

[3] Yankey BA, Rothenberg R, Strasser S, Ramsey-White K, Okosun I. Effect of marijuana use on cardiovascular and cerebrovascular mortality: A study using the National Health and Nutrition Examination Survey linked mortality file. Eur J Prev Cardiol. 2017;0(00):1-8.

 

 

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