Cannabis use may confer increased admission for acute MI, worse outcomes in PCI
Cannabis use in the U.S. is rising, and although users are typically younger, their risk for acute MI is elevated, and after PCI, cannabis users may be at increased risk for bleeding and stroke compared with nonusers, researchers reported.
Two studies presented at the virtual American Heart Association Scientific Sessions explored the prevalence of cannabis use among patients who presented with acute MI in addition to their outcomes after PCI.
Cannabis and MI
One assessment utilized the National Inpatient Sample to determine the prevalence and impact of cannabis use among individuals with prior MI, PCI or CABG.
Overall, patients who used cannabis and had a history of MI and revascularization were younger (median age, 53 vs. 72 years), more likely to be Black (34.3% vs. 10%) and more likely to be men (76.5% vs. 61.5%) compared with nonusers (P < .001).
From 2007 to 2014, investigators observed cannabis use increase from 0.2% to 0.7%, according to the study.
“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,” Rushik Bhuva, MD, cardiology fellow with the Wright Center for Community Health in Scranton, Pennsylvania, said in a press release. “In addition, the role of medicinal cannabis, its benefits and potential risks with regard to cardiovascular management needs to be validated in larger studies.”
Although patients who used cannabis had a lower prevalence of hypertension (71.7% vs. 74.8%), diabetes (23.6% vs. 32.9%) and dyslipidemia (51.3% vs. 57.8%; P < .001), the rising trend of cannabis use was accompanied by a greater rate of acute MI (7.2% vs 4.5%), PCI (6.2% vs 5.5%) and CABG (1.9% vs 1.5%) compared with nonusers.
Moreover, all-cause mortality (0.8% vs 2.5%) and hospital charges ($21,556 vs. $24,872) were low among cannabis users, according to the study. However, subsequent acute MI was more prevalent among cannabis user compared with nonusers (67% vs. 41%).
“There was an alarming rise in the trend of cannabis use among patients who have already had a heart attack or coronary revascularization procedure during the study period,” Bhuva said in the release. “Another concerning finding was that the frequency of recurrent heart attacks and cardiac interventions was higher among cannabis users, even though they were younger and had fewer risk factors for heart disease.”
Cannabis and PCI
In a second analysis, Sang Gune Yoo, MD, internal medicine resident physician at the University of Michigan, and colleagues evaluated the statewide Blue Cross Blue Shield Michigan Cardiovascular Consortium (n = 113,477; 3.5% self-identified cannabis users) to determine the association between cannabis use and in-hospital outcomes after PCI. Cannabis users were matched one-to-one with nonusers and evaluated for the primary outcome that included post-procedural stroke, transfusion, bleeding, acute kidney injury and death.
“As marijuana is becoming more accessible across the U.S., there is a need for rigorous research to better understand the effects of marijuana use on cardiovascular health,” Yoo said in a press release.
In agreement with the first study, cannabis users were more likely to be younger (mean age, 53.9 years vs. 65.8 years) and male (79.2% vs. 66.8%). The cannabis user group had a high prevalence of cigarette smokers (73% vs. 26.8%) and were more likely to present with STEMI (27.3% vs. 15.9%).
Investigators found that, after PCI, cannabis users experienced elevated risk for bleeding (adjusted OR = 1.54; 95% CI, 1.2-1.97; P < .001) and stroke (aOR = 11.01; 95% CI, 1.32-91.67; P = .026) and a decreased risk for acute kidney injury (aOR = 0.61; 0.42-0.87; P = .007).
There were no differences in the risks for transfusion (OR = 1; 95% CI, 0.69-1.44) or death (OR = 0.94; 95% CI, 0.54-1.62).
“Although people who smoke marijuana may be at higher risk for complications such as stroke and post-PCI bleeding, this should not deter patients who use or have used marijuana from pursuing potentially lifesaving PCI procedures,” Yoo said in the release. “As marijuana use continues to increase, medical professionals and patients should be aware of these increased risks of complications after PCI. Physicians should screen and counsel patients about marijuana prior to their procedure due to the risks of serious complications.”
Reference:
- Yoo SK, et al. Clinical and hospital-based observational studies. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).
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Desai R, et al. Substance use and CVD: Nicotine, marijuana and other drugs. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).