Cannabis use associated with elevated cardiovascular disease risk

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By Lisa Rapaport

(Reuters Health) - Individuals who use cannabis have a higher risk of cardiovascular disease risk factors compared to counterparts who don't use the drug, a recent study suggests.

Researchers examined data on 7,159 adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018, which assessed cannabis use by self-report. Researchers assessed composite cardiovascular risk based on the American College of Cardiology/American Heart Association 10-years atherosclerotic cardiovascular risk (ASCVD) scores.

Overall, 4,573 (63.9%) of participants in the study reported cannabis use. Compared with people who never used cannabis, those who reported cannabis use were significantly more likely to have borderline ASCVD scores, with a 5.0-7.4% 10-year risk (odds ratio 1.51). They were also more likely to have intermediate ASCVD scores, with a 7.5%-19.9% 10-year risk (OR 1.49), and high ASCVD scores, with at least a 20% 10-year risk (OR 1.60).

"The chemical constituents of cannabis smoke and tobacco smoke are similar, so there may be similar mechanisms at play, but this has yet to be definitively proven," said lead study author Dr. Travis Milan Skipina, of the Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

"Also, concurrent tobacco use is very common among cannabis users, so it is possible that an additive or synergistic effect exists," Dr. Skipina said by email.

A total of 1,585 (34.7%) people who reported cannabis use said they were current tobacco smokers, compared with 275 (10.6%) of individuals who said they had never used cannabis.

Compared with never users, current cannabis users were significantly more likely to have intermediate (OR 1.37) and high (OR 1.41) ASCVD 10-year risk scores.

The increased risk relative to never users was even more pronounced when people reported using cannabis every month for at least one year. Compared with never users, these monthly users were significantly more likely to have both intermediate (OR 1.96) and high (OR 1.87) ASCVD 10-year risk scores.

People who used cannabis at least once a day also had significantly greater likelihood of intermediate (OR 1.94) and high (OR 1.87) ASCVD 10-year risk scores than never-users.

Researchers also found a dose-response relationship between cannabis use and ASCVD 10-year risk scores, with scores of 2.95 for never users, 3.29 for current users, 3.92 for monthly users, and 3.91 for daily users.

One limitation of the study is the potential for self-reported cannabis use data to be subject to recall bias, leading to underestimated utilization, the study team notes in the American Journal of Cardiology. Researchers also lacked data on the methods of cannabis use, quantities used, or long-term history including any periods of abstinence.

It's possible that edibles might have less cardiovascular risk, for example, compared with smoked or other combustible products, Dr. Skipina said. However, more research is needed to determine this.

In the meantime, all patients who report cannabis use should be screened for adverse cardiometabolic risk factors and they should be informed regarding their elevated risk of cardiovascular events, Dr. Skipina said.

"Steps should be taken to optimize other modifiable risk factors, and patients should be urged to use cannabis with caution given the numerous associations with adverse cardiovascular events," Dr. Skipina said.

SOURCE: https://bit.ly/3qo6dJK American Journal of Cardiology, online December 16, 2021.

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