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Cannabis Use Variations and Myocardial Infarction: A Systematic Review
Jan van Amsterdam1,2, Wim van den Brink1,2
1Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
Insights
Cannabis smoking, unlike vaping or edibles, independently increases myocardial infarction (MI) risk, even in non-tobacco users. This highlights combustion as a key factor in cannabis-related cardiovascular events.
Area of Science:
- Cardiovascular Disease Epidemiology
- Cannabis and Public Health
- Toxicology of Smoke Inhalation
Background:
- Cannabis use is linked to increased coronary heart disease (CHD), including myocardial infarction (MI) and angina pectoris (AP).
- The independent risk of cannabis use for MI is unclear due to frequent co-use with tobacco.
- Investigating the specific risks associated with different cannabis consumption methods (smoking, vaping, edibles) is crucial.
Purpose of the Study:
- To determine if cannabis is an independent risk factor for myocardial infarction (MI).
- To compare the cardiovascular risk of MI across different cannabis consumption methods: smoking, vaping, and edibles.
- To assess the impact of concurrent tobacco use on cannabis-related MI risk.
Main Methods:
- Systematic review conducted following PRISMA guidelines.
- Searches performed across Medline (PubMed), Embase, and Google Scholar databases.
- Analysis of 22 eligible studies to evaluate associations between cannabis use and MI.
Main Results:
- Cannabis smoking showed a significant association with MI (aORs 1.03–5.24) even after adjusting for tobacco use.
- Frequent cannabis smoking posed a significant MI risk (aOR = 1.88) even in individuals who never used tobacco.
- Cannabis vaping and ingestion (non-smoking forms) were not significantly associated with increased cardiovascular risk (frequent use: aOR = 1.00 ns; current use: aOR = 1.31 ns).
Conclusions:
- Cannabis smoking may independently trigger myocardial infarction (MI), similar to tobacco smoking.
- Non-combustible cannabis consumption methods like vaping and ingestion appear less harmful.
- Reduced harm from vaping/ingestion likely stems from avoiding toxins present in cannabis smoke, such as carbon monoxide.
Abstract:
Background: Cannabis use is associated with an increased risk of coronary heart disease (CHD), including angina pectoris (AP), and myocardial infarction (MI). However, it is not clear whether cannabis use is an independent risk factor of AP and/or MI, because cannabis is often smoked together with tobacco. We investigated whether cannabis is an independent risk factor of MI and whether this risk is similar in cannabis smokers, cannabis vapers, and those who use cannabis edibles. Methods: A systematic review was performed, according to the PRISMA guidelines and using Medline (PubMed), Embase, and Google Scholar as databases. Results: Twenty-two eligible papers were identified. After adjustment for concurrent tobacco use, cannabis smoking remained significantly associated with incidents of MI, with aORs ranging between 1.03 and 5.24, and particularly high aORs in the younger age group. In never-tobacco smokers, frequent cannabis smoking was also associated with a significant MI risk (aOR = 1.88). Frequent and current cannabis use in any form other than smoking (e.g., vaping, but mostly ingestion) was not associated with a significantly increased cardiovascular risk (frequent use: aOR = 1.00 ns; current use: aOR = 1.31 ns). Conclusions: Like tobacco smoking, cannabis smoking may independently provoke MI. Vaping and ingestion of cannabis might be less harmful, probably because absence of combustion prevents exposure to certain toxins in cannabis smoke, including carbon monoxide.
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