Arrhythmia signal may exist after cannabis use for chronic pain; no link with HF, ACS
In a Danish cohort, use of medical cannabis for chronic pain was associated with an 83% increased risk for arrhythmias, researchers reported at the European Society of Cardiology Congress.
The researchers found no relationship between medical cannabis use and risk for ACS or HF.
The relationship between medical cannabis use and arrhythmias was most prominent in patients with cancer, according to the researchers.
For the study, Nina Nouhravesh, MD, a PhD candidate at Gentofte University Hospital in Copenhagen, Denmark, and colleagues used a Danish register of 1.8 million patients with chronic pain who were followed from 2018 to 2021.
All patients had no history of arrhythmias, HF or ACS and no prior use of prescribed medical cannabis.
Each patient prescribed medical cannabis during the study period was matched 1:5 — based on age, sex, chronic pain diagnosis and use of other pain medications — with controls not prescribed medical cannabis.
“Medical cannabis use was introduced in Denmark in January 2018 on a trial basis, meaning that any doctor can prescribe it on a medical basis for chronic pain if all other measures have been tried,” Nouhravesh said during a presentation. “However, data on side effects, especially cardiovascular side effects, are very sparse.”
The analysis consisted of 5,071 patients prescribed cannabis for chronic pain and 25,342 patients with chronic pain not prescribed cannabis. The median age was 60 years and 37% were men.
Among the cohort, 35% had musculoskeletal pain, 18% had cancer, 14% had neurological pain and 33% had other types of pain, Nouhravesh said.
The cannabis group tended to have higher use of other types of pain medications compared with the control group, she said.
The standardized 180-day absolute risk for arrhythmia was 0.86% in patients prescribed medical cannabis compared with 0.47% in controls, for an RR of 1.83, Nouhravesh said during the presentation.
The risk difference for arrhythmia between the cannabis group and the control group was most prominent in patients with cancer (0.98; 95% CI, 0.28-1.89), she said, noting the risk difference was slightly but not significantly elevated in the cannabis group in the other pain subtypes.
“We found medical cannabis to be associated with an 83% risk increase of arrhythmias compared with the control patients matched on age, sex, pain diagnosis and other pain treatment at baseline,” Nouhravesh said during the presentation. “In a subgroup analysis, we found cancer patients to exhibit the largest risk, though there was a trend toward increased risk in all subgroups.”
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Holt A, et al. Abstract 83165. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).
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