Some info is emerging about marijuana use in the young and cardiovascular problems

[Yo_Mama]

I read this in Medscape, but that's a subscription (free) site:
http://www.medscape.com/viewarticle/824049?src=wnl_edit_medn_wir&uac=79280DR&spon=34

Here are some other links:
http://thechart.blogs.cnn.com/2014/04/23/marijuana-use-linked-to-heart-problems/
http://jaha.ahajournals.org/content/3/2/e000638.full?sid=a7d9834b-0755-446d-b5f7-8a1cef51e92a
http://jaha.ahajournals.org/content/3/2/e000904.full?sid=a7d9834b-0755-446d-b5f7-8a1cef51e92a

The 2006 CARDIA study showed that marijuana use is associated with hypertension, dyslipidemia, and higher caloric intake, all of which may increase the incidence of coronary artery disease.10 In light of the probable effects of marijuana on increasing platelet coagulability11 and its frequent combined use with smoking tobacco or other illicit drugs, it is not surprising to note these reports of myocardial infarctions. In a review of 3882 patient interviews, Mittleman et al12 found a significant 4.8‐fold increase in the incidence of myocardial infarction over baseline in the first hour after marijuana use. Similarly, a 4.2‐fold increase in mortality rate was observed in marijuana users compared with nonusers following myocardial infarction.13

The reason it caught my eye is that this is the only explanation we can find for a 24 year old very fit female with recurrent bouts of tachycardia, and the tachycardia is so serious that we are sending her for a full CV workup.

I also have some preliminary associations showing that it isn't safe for diabetic patients with any trace of CV, and that includes vasoconstriction, to which some people have a natural (genetic) propensity, and which is strongly associated with Type II and CV in the younger cohort.

I can't stress enough that the strength of the association is not known and it may prove that it is confined to people with certain traits only. Doctors do and will continue to prescribe marijuana or THC for some conditions. But it may be prove to be like other drugs - beneficial to some and harmful to others.

There is a strong association with schizophrenia. That much is proven.

All of this puts doctors in an awkward position. We are updating our risk matrix at the clinic to include marijuana use in a number of conditions. However the JAHA suggestion to report adverse medical events to the state (which would be a mandate) would put doctors in a more difficult position with respect to their patients, because they might not be honest if they knew it were to be disclosed, unless an ironclad guarantee of confidentiality were provided.

I thought DU should be aware of both the medical trend here and the possible political implications. I still favor legalization, which would at least leave any problem as a medical issue only, and not a medical/legal problem. And this sort of reporting would be helpful - but I would not want to see mandatory reporting without complete confidentiality in the US.

I do think this is a serious problem for some. When these CV associations occur, they seem to be very serious in the young.

[4now]

1. Thank you for your concern trolling

[Comrade Grumpy]

2. Here's what NORML has to say about that:

Dr. Mitch Earleywine is Professor of Psychology and director of clinical training at SUNY-Albany. He is the author of "Understanding Marijuana: A New Look at the Scientific Evidence."

_____________________________________________________

New Study Tells Nothing About Marijuana’s Role in Heart Disease

by Mitch Earleywine
A new study on marijuana appeared in Journal of the American Heart Association. These are interesting data, but we have to interpret them very carefully.

Sure, we know cannabis can raise heart rate briefly, but most users develop tolerance to the effect. We’ve also seen (in a much larger sample) that it doesn’t increase mortality rates even among survivors of heart attacks.

But the new study made the news anyway. Investigators specifically searched a French database where physicians are legally bound to report any drug-related case that they view as “leading to temporary or permanent functional incapacity or disability, to inpatient hospitalization or prolongation of existing hospitalization, to congenital anomalies, or to an immediate vital risk or death.”

They then looked for cannabis users and found a shade less than 2,000 in the past 5 years. It’s impossible to know what that number means without knowing the number of people these physicians saw or how many patients used cannabis and did not end up reported to this database.

They then found a whopping 35 of these who had cardiac complications. It is impossible to know what to make of this number without knowing the number of cannabis users in France, which the authors report is 1.2 million. If you divide 35 by 1.2 million you get roughly .00003. I’m guessing that not all these cannabis users went to the doctor and not every person who used cannabis and had cardiac complications fessed up to the doctor, so let’s say that we’re off by two orders of magnitude. Let’s give the prohibitionists the benefit of the doubt and multiply by 100. That’d put the rate of problems up to .003.

If those are the chances of having cardiac complications as a French cannabis user, my first thought is that using cannabis protects people from cardiac problems. We need a comparison group of people who don’t use cannabis to know their rate of cardiac problems, but, as the authors point out, we simply don’t have those data. The closest estimates were 57 per 10,000 people, based on another study, which is .0057, or almost twice as bad as the rate among the cannabis users (after our generous overestimation). I’m not going to hold my breath for the the headline, “Cut your heart disease in half with cannabis.”

In short, this study tells us a lot about what kinds of cardiac complications appeared in people who were reported to the French government for cannabis-related problems, but tells us little about the link between cannabis use and cardiovascular disease.

- See more at: http://blog.norml.org/#sthash.JXNyJUnn.dpuf

[Rex]

14. Of course this will be ignored, the narrative must stand. nt.

nt.

[antiquie]

3. "There is a strong association with schizophrenia. That much is proven."

Harvard: Marijuana Doesn’t Cause Schizophrenia

Not all scientists agree.

[Yo_Mama]

20. Association is NOT causation

How many times does that have to be said, written, whatever.

The reason why the association with schizophrenia is relevant here is that vasoconstriction and vascular inflammation may be a risk factor for schizophrenia, and are certainly a risk factor for cardiovascular disease.
http://www.biomedcentral.com/1471-2350/6/7

The best guess is that some people are predisposed to schizophrenia, and under the right conditions will develop it. People who are predisposed to CV disease due to vasoconstriction may have the same fundamental trigger.

[RainDog]

23. Yes. That's what meta analysis has shown

Marijuana is not implicated as causation for schizo-affective disorders.

There is some evidence that marijuana may impact age of onset - which is a good argument to note that ANYONE, no matter their age, who is at risk of a schizo-affective disorder (based upon family history) would do well to avoid marijuana - just as those with a history of alcoholism in their family would be cautioned that they may be at greater risk of that condition if they drink alcohol - and a younger age for use would factor into this.

There have been two or three meta analyses that demonstrate no causation - so I think that's pretty firmly established.

Roger Pertwee, the leading pharmacologist in the UK whose speciality is cannabis-based medicine research also went on record, publicly to state there is no causation risk for schizophrenia for the general public - only for those who are already at risk of the same.

[Yo_Mama]

24. Right - for some people it may be causative, we don't know how to distinguish that

http://www.psychiatrictimes.com/schizophrenia/cannabis-psychosis-link/page/0/1

But that may not be true. It could well be that those who are already at an increased risk of schizophrenia are more likely to use cannabis, and at higher dosages, thus accounting for the association and the dose response that seems to show up.

The only way you could know for sure is to grab a bunch of kids at risk for schizophrenia and have half of them start using at an early age and pay the other half not to use, and see what happens. But, given the strong association, it would be totally unethical so it is never going to be done.

[RainDog]

26. But the meta analyses ruled out causation

The way they did this was to look at rates of schizophrenia in populations relative to the rates of marijuana use.

An increase in marijuana use should lead to an increase in schizophrenia if marijuana caused schizophrenia.

This was not the case.

HUNDREDS OF THOUSANDS of people were involved in these meta analysis - far, far more statistical validity than any single test.

The leading pharmacologist in the UK said, in 2010:

Roger Pertwee, professor of neuropharmacology at Aberdeen University, will on Tuesday tell the British Science Festival in Birmingham that making cannabis available from licensed outlets would reduce drug-related crime and cut the risk of users moving on to more dangerous drugs.

“At the moment cannabis is in the hands of criminals,” he will say. “We are allowed to drink alcohol and smoke cigarettes. Cannabis, if it is handled properly, is not going to be more dangerous.”

Although research has shown cannabis may increase the risk of developing schizophrenia in particularly vulnerable individuals, this danger does not apply to the general population, he will say. The risk could be reduced by setting a minimum age of 21 for consuming cannabis or requiring individuals to obtain a licence to buy it.

http://journals.democraticunderground.com/RainDog/23


studies from Harvard published late last year: http://www.democraticunderground.com/11701551

and a meta analysis of marijuana studies have indicated that marijuana was only a risk for schizophrenia for those with existing family histories, and, therefore, existing predisposition for schizo-affective disorder:

http://www.abc.net.au/science/articles/2009/09/01/2673334.htm

Previous research has suggested cannabis use increases the risk of being diagnosed with schizophrenia or other psychotic disorders.

This latest study, led by Dr Martin Frisher of Keele University, examined the records of 600,000 patients aged between 16 and 44, but failed to find a similar link.

"An important limitation of many studies is that they have failed to distinguish the direction of association between cannabis use and psychosis," the authors write in the latest edition of the journal Schizophrenia Research.

[Yo_Mama]

28. They didn't rule out causation in indivduals

Most things that cause health problems fall into that category. They are only a problem for people who are susceptible to a certain condition.

You can't pick those sorts of things out from general population studies unless a relatively large portion of the general population has the susceptibility.

[RainDog]

30. If individuals were at risk for schizo-affective disorders

then those individuals would account for an increase in schizo-affective disorders with the increased use of cannabis.

But schizo-affective disorders in populations have maintained stable rates - which would indicate these disorders are heritable, not caused by outside agents - since, again, various social conditions exist in relation to various substances over time but rates of schizophrenia remain stable.

You can most certainly draw a conclusion about individuals based upon the reality that rates of the disorder are not impacted by increased rates of mj use.

[RainDog]

29. It's interesting that someone was writing about this

When, two years before the article was written, those who are primary researchers in this field had already disproved the question posed by the article.

I would assume someone would do more "due diligence" before publishing such an article.

[Cooley Hurd]

4. Chances are, these "case studies" were couch-potatoes long before smoking weed...

I'm a regular smoker, and I LOVE to get on my bike and ride 10+ miles when I'm baked. And my bad cholesterol and BMI are well in the healthy range. Sooo... what's yer point?

[SomethingFishy]

11. These studies are ridiculous... First of all, what kind of weed was it?

The days of thinking all Cannibis is the same are over. There is pot for being a couch potato, there is also pot for riding your bike, for working, for pain relief, for focusing...

The only thing that study showed was that pot gives you the munchies. Hypertension? Marijuana is a fucking cure for that. Dyslipidemia, (had to look that one up) and higher caloric intake, thats from the diet not Cannibis.

We will be seeing much more of this. Hyperbolic headlines about increases in "marijuana related DUI's, accidents, and if they are really desperate, as some have already been, overdoses and deaths, will be the order of the day as more and more states legalize.

[eShirl]

12. and my munchies were always for fresh whole foods like fruits & veggies

[Yo_Mama]

25. My point is that a specialized reporting system is being suggested

Now, medically it's warranted, because we do know that some young healthy people are having very serious CV events from using marijuana. You can slap them on a heart monitor and have them smoke, and watch the cardiac havoc unfold before your eyes. Okay? And I've got to tell you that we've got others who have apparently great labs, but when you start doing the full analysis the inflammation jumps out at you. These are young people. It does appear that for an unlucky few, something is happening.

We DON'T know how common it is. We suspect that it's quite uncommon, because otherwise there would be dead bodies all over the place.

Finding that link probably would require a CV event reporting system, but if this is done in places in which pot is illegal, then confidentiality should be ironclad! I would think pot smokers would care about this!

If you will read the post, you'll see what I am saying. Knowledge is good. If you legalize marijuana, then this can be done without a problem. But right now it's still illegal in a lot of states, and I don't think doctors want to be slapped with mandatory reporting without mandatory confidentiality. Like HIV. Right? You are trying to treat the patient, and you don't want anything to get in the way of it. And WTF are we supposed to do if we are given a mandate to report without an assurance of confidentiality?

I would think people who use pot would get why this could be an issue! You need to be able to be honest with your doctor without taking chances of getting some over-zealous cop jumping down your throat. Your doctor needs to be able to ask you the question without fearing that if he charts honestly he may take the chance of violating some damned law, or having to report something to a state system that doesn't have legal confidentiality built in which could screw you, the patient.

[hobbit709]

5. taurine metabolic byproduct.

[theaocp]

6. Thank gawd we have prohibition to save these young people. n/t

[Rex]

7. Here some FUD, there some FUD, everywhere some FUD FUD!

Ol' McBooze had some FUD...beer bong, beer bong O.

We all know that triangle man can beat up suds man, but can he beat ganja man?

"Ganja man, ganja man, scrambles eggs in a frying pan." "Is he hungry or just have the munchies?" "Nobody knows about ganja man."

[Tikki]

8. Thank you for posting this…this sounds important for anyone who wants to start young and..

should talk to their doctor about usage if there is any family history of diabetes or cardio-vascular disease.

Why wouldn't you ask your physician questions about this?


Tikki

[Warren Stupidity]

15. because your physician will have as much data as went into and came out of this study: zero.

So an honest physician will tell that he has no idea if there are any cardio risks associated with smoking pot.

[Tikki]

16. Or he will have info…

You can always ask your doctor if there is any new information as the studies continue.

Better to know.

Tikki

[Yo_Mama]

19. Or if you have early symptoms.

It's just one more thing to rule out.

[Tikki]

22. Yes, we need to tell our physicians everything we regularly put into our systems.

And trust that communication on both sides is a benefit.



Tikki

[Yo_Mama]

27. Which it will not necessarily be if a mandatory reporting system is instituted.

Hell, just because some people have a bad reaction doesn't mean that it should be banned. But the point is that if you find that a patient has violent reactions to wheat products, you can record that knowing that the info will be there, so that if they arrive at a hospital they'll be treated appropriately.

We don't have that assurance right now with pot.

[Politicalboi]

10. I've been smoking pot for over 30 years

I just lost a friend of 37 years with cancer, non smoker, and she smoked pot back in the 80's but never a lot, not not beyond the 80's. I had another friend die in 2009 with cancer, smoker, and she used to smoke more pot in the 80's and 90's, but she didn't smoke much after that. Me on the other hand, drinks about 6 soda's a day, I smoke, I usually only eat one meal or a small lunch and dinner, and I weigh about 125. EVERYONE is different.

[Yo_Mama]

18. Exactly - some people can't eat wheat -

which of course is not a reason to ban wheat!

The question from a medical point of view is about individual health risks.

However when you start seeing this sort of thing show up, it does raise medical issues. I'm relatively sure that for a lot of people, some pot use is healthy, because it lowers stress levels.

Finding those individuals for whom it may be a problem is the medical issue. Instituting mandatory reporting without confidentiality or legalization is, IMO, NOT THE SOLUTION.

[otohara]

37. 6 Sodas?

Yikes - that's a lot of sugar

[Union Scribe]

13. Thanks for posting.

Please ignore those have responded aggressively. Even suggesting pot isn't great for everyone is seen as blasphemy by many here.

[RainDog]

17. Good information

thanks for posting.

one problem, as mentioned, was the correlation with tobacco use, of course.

I wonder how this work compares to reports of lower levels of fasting insulin, cholesterol and weight. Caloric intake versus bmi, etc.

http://www.sciencedaily.com/releases/2013/05/130515085208.htm

http://www.amjmed.com/article/S0002-9343%2813%2900200-3/abstract

There are limited data regarding the relationship between cannabinoids and metabolic processes. Epidemiologic studies have found lower prevalence rates of obesity and diabetes mellitus in marijuana users compared with people who have never used marijuana, suggesting a relationship between cannabinoids and peripheral metabolic processes. To date, no study has investigated the relationship between marijuana use and fasting insulin, glucose, and insulin resistance.

Methods
We included 4657 adult men and women from the National Health and Nutrition Examination Survey from 2005 to 2010. Marijuana use was assessed by self-report in a private room. Fasting insulin and glucose were measured via blood samples after a 9-hour fast, and homeostasis model assessment of insulin resistance (HOMA-IR) was calculated to evaluate insulin resistance. Associations were estimated using multiple linear regression, accounting for survey design and adjusting for potential confounders.

Results
Of the participants in our study sample, 579 were current marijuana users and 1975 were past users. In multivariable adjusted models, current marijuana use was associated with 16% lower fasting insulin levels (95% confidence interval [CI], −26, −6) and 17% lower HOMA-IR (95% CI, −27, −6). We found significant associations between marijuana use and smaller waist circumferences. Among current users, we found no significant dose-response.

Conclusions
We found that marijuana use was associated with lower levels of fasting insulin and HOMA-IR, and smaller waist circumference.

Studies also indicate THC provides cardio protection in low doses -

A single ultra low dose of THC before ischemia is a safe and effective treatment that reduces myocardial ischemic damage.

http://www.ncbi.nlm.nih.gov/pubmed/23537701

(the same scientist demonstrated neuro-protection from low dose THC as well)
http://link.springer.com/article/10.1007/s00221-012-3186-5

Delta-9-tetrahydrocannabinol protects cardiac cells from hypoxia via CB2 receptor activation and nitric oxide production.

http://www.ncbi.nlm.nih.gov/pubmed/16444588

THC fights hardened arteries.

The study is behind a pay wall, but here's one article about it, below the study link.

http://www.nature.com/nature/journal/v434/n7034/full/434708a.html

http://www.webmd.com/heart-disease/news/20050406/marijuana-chemical-fights-hardened-arteries

The active ingredient in marijuana that produces changes in brain messages appears to fight atherosclerosis -- a hardening of the arteries.

The results may be due to THC's anti-inflammatory properties, write the researchers, who included François Mach, MD, of the cardiology division at University Hospital in Geneva, Switzerland. Inflammation has been shown to be associated with the development of atherosclerosis.

This, of course, does not mean that some people can't have increased heart rates from the use of marijuana - but does demonstrate some cardio-protective features in low doses - lower than those most people would have if they inhaled marijuana.

[2pooped2pop]

21. paranoia, with munchies? Who knew?

Last edited Fri Apr 25, 2014, 06:30 PM - Edit history (1)

Was a study really necessary? I also don't know anyone advocating it's use in healthy children.

And I will take the studies done that shows helpfulness to heart, prevents alzheimers, cancer treatment, as well as the comfort issues over any study coming out trying after all of these years to come up with negatives.

[Lint Head]

31. Now that pot will soon be legal everywhere the fear mongering

is coming out of the woodwork.

[Yo_Mama]

32. In people prone to vasoconstriction, pot has caused amputations.

http://www.ncbi.nlm.nih.gov/pubmed/11205926?dopt=Abstract
OBVIOUSLY it's not a severe problem for most users. That doesn't mean it's good for everyone, and in any case, the point of the post is to alert potheads to a potential vulnerability in their medical treatment.

The purpose of this paper was to revisit the old concept of cannabis arteritis first described in the 1960s and report 10 new cases. Ten male patients, with a median age of 23.7 years developed subacute distal ischemia of lower or upper limbs, leading to necrosis in the toes and/or fingers and sometimes to distal limb gangrene. Two of the patients also presented with venous thrombosis and three patients were suffering from a recent Raynaud's phenomenon. Biological test results did not show evidence of the classical vascular risk factors for thrombosis. Arteriographic evaluation in all cases revealed distal abnormalities in the arteries of feet, legs, forearms, and hands resembling those of Buerger's disease. A collateral circulation sometimes with opacification of the vasa nervorum was noted. In some cases, arterial proximal atherosclerotic lesions and venous thrombosis were observed. All patients were moderate tobacco smokers and regular cannabis users. Despite treatment with ilomedine and heparin in all cases, five amputations were necessary in four patients. The vasoconstrictor effect of cannabis on the vascular system has been known for a long time. It has been shown that delta-8- and delta-9-tetrahydrocanabinols may induce peripheral vasoconstrictor activity. Cannabis arteritis resembles Buerger's disease, but patients were moderate tobacco smokers and regular cannabis users. These cases show that prolonged use of cannabis could be an additive risk factor for juvenile and young adult arteritis. Cannabis arteritis is a forgotten and severe occlusive vascular disease occurring in young adults. Search for cannabis use may be an important tool for a better knowledge of arteritis in young smokers.

The significance is that if you walk into a doctor's office with certain problems, marijuana use MAY be a factor. It's been officially included in the European SCORE system (rates CV risks). That doesn't mean pot is bad for any one individual, or for most. It means that in CERTAIN individuals we KNOW it causes a problem, and those problems can lead to death at an early age. We should be formally evaluating a lot of people for this risk and we aren't.

All of this would be pretty ho-hum if it weren't for the fact that pot is illegal in most states, that the proposed state reporting systems are very similar to those in the past commonly tapped by the feds, and that while the reporting system might be medically good, it's probably not going to work without ironclad confidentiality, because doctors simply don't want to cause future problems for their patients.

This is NOT alarmism or fear mongering. It's probably along the lines of celiac disease in incidence, but the thing is that wheat isn't illegal, so medical professionals don't have a problem with recording that diagnosis in a person's medical records.

[Lint Head]

34. For people with ulcers aspirin can cause them to bleed and death.

[hobbit709]

36. And the tobacco had absolutely no effect? Give me a break.

[RainDog]

38. All those reported were cigarette smokers, too

Since Buerger's disease is highly associated with tobacco smoking/use (smokeless tobac too) - why is this called cannabis arteritis?

Cannabis cannot be considered the primary cause when THE known primary cause is part of the patient's medical past and present.

Since cannabis is a known anti-inflammatory (THC and CBD) - why would an anti-inflammatory create inflammation? And, again, why is this linked to cannabis when tobacco is present, does not have anti-inflammatory properties, and is considered to be the PRIMARY CAUSE of such disease?

That's really strange, to me.

Can you explain why cannabis would be named but not tobacco? this is an honest question because this is the first time I've ever seen any reports on Buerger's disease called cannabis arteritis.

[Jesus Malverde]

33. "higher caloric intake"...

[hedgehog]

35. I think the suggestion that marijuana is somehow a miracle drug that never brings harm and cures

all ills is ludicrous. I have no doubt that we will discover that some people have genetic profiles which make the use of marijuana risky (for example - high risk that marijuana use will activate schizophrenia), that young developing brains shouldn't be exposed to marijuana and that it will be shown that heavy use can be harmful.

For comparison, there is a high rate of alcoholism in my family, so I never started drinking. I know people with fetal alcohol syndrome. I've seen people in my family die young from liver disease brought on by heavy drinking. Does this mean that alcohol should be banned? Absolutely not. In fact, my husband and one of my sons brew their own beer. But it does mean that alcohol should be used judiciously by all and never at all by some.

I would also note that moderate use of alcohol has been presented as being beneficial to health for some people. I will allow that the same may be true of marijuana. We are in early days of learning all there is to know about this drug.