Marijuana Use Tied to Repeat MI, Stroke After PCI

AHA 2020
20 Nov, 2020 ,

A recent study suggests that Marijuana use was associated with a higher prevalence of recurrent myocardial infarction and a greater risk of bleeding or stroke after percutaneous coronary intervention. Both studies "add to our accumulating knowledge of the cardiovascular risks of marijuana," Ersilia M. DeFilippis, MD, a cardiology fellow at Columbia University Irvine Medical Center, New York City, who was not involved with this research, told theheart.org | Medscape Cardiology.

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Marijuana use was associated with a higher prevalence of recurrent myocardial infarction (MI) and a greater risk of bleeding or stroke after percutaneous coronary intervention (PCI) in separate studies.

Rhushik Bhuva, MD, presented the recurrent-MI results from a national US study, and Sang Gune K. Yoo, MD, presented the PCI study, which used data from a Michigan cohort. The studies were presented at the virtual American Heart Association (AHA) Scientific Sessions 2020.

Both studies "add to our accumulating knowledge of the cardiovascular risks of marijuana," Ersilia M. DeFilippis, MD, a cardiology fellow at Columbia University Irvine Medical Center, New York City, who was not involved with this research, told theheart.org | Medscape Cardiology.

DeFilippis and the two study authors say clinicians and patients need to be more aware of cardiovascular risks from smoking marijuana, and they call for more patient screening, counseling, and research.

Need for Screening, Counseling

Marijuana is a Schedule 1 controlled substance in the United States, which makes it illegal to conduct rigorous controlled trials of marijuana products. Existing knowledge is therefore based on observational studies, DeFilippis noted.

She was lead author of a review of marijuana use by patients with cardiovascular disease. The review was published in January 2020 in the Journal of the American College of Cardiology. An AHA scientific statement about marijuana and cardiovascular health was published in Circulation in August 2020.

Both documents drew attention to risks from marijuana use in patients with cardiovascular disease.

Until more data are available, "I think it's absolutely critical" that cardiologists and general providers screen patients for marijuana use, "either at the time of their MI or ideally prior to that, when they are making a cardiovascular risk assessment," said DeFilippis.

That is also the time to "counsel patients, especially those who have had an MI, about risks associated with continuing to use marijuana."

Importantly, providers and patients need to be aware that "cannabinoids, through the cytochrome P450 system, can interact with well-known cardiovascular medications, which we know provide benefit in the post-MI period," she added. "For example, marijuana can interfere with beta blockers, statins, antiarrhythmics, and certain anticoagulants."

Bhuva, a cardiology fellow with the Wright Center for Community Health, Scranton, Pennsylvania, said that it is "concerning" that "recurrent heart attacks and cardiac interventions [were] higher among cannabis users, even though they were younger and had fewer risk factors for heart disease.

"Spreading awareness regarding the potential risk of recurrent heart attacks in middle-aged, African American and male cannabis users and screening them at an earlier age for potential risk factors of future heart attacks should be encouraged among clinicians," he urged in a statement from the AHA.