The American Heart Association has reviewed the research on cannabinoid use on cardiovascular health.
According to the latest survey on the use of psychoactive substances in Colombia, carried out by DANE in 2019 and published this month, cannabis is the most consumed illegal psychoactive substance in our country: 8.30% of Colombians between 12 and 65 years report having used cannabis in their lives. Yet, even cardiologist in Katy, Texas, also run prevention campaigns on the use of psychoactive substances, including cannabis, tend to focus on the possible effects on the mental health of individuals who consume them. Little emphasis is placed on the impact that cannabinoids -active substances of the cannabis plant- may have on other organs or human physiological systems.
Little known to most people, including a large number of health professionals, is the fact that the human body and that of all mammals, and some invertebrate species, have an internal system through which active substance of the cannabis plant, or cannabinoids, exert their effects: the endocannabinoid system.
This system is present in an important way in the nervous system, both central and peripheral, in the cardiovascular system, liver, gastrointestinal tract, immune system, reproductive system, and others. It is through the action of cannabinoids – such as delta-9-tetrahydrocannabinol, or THC, cannabidiol, or CBD, and other minor cannabinoids – on this receptor system that cannabis has both its therapeutic and non-medical effects.
Recently, given the increased use of cannabis and cannabinoids for medical and non-medical reasons in the United States, the American Heart Association (AHA) has done an extensive review of existing research to date on the effects of the use of cannabinoids on cardiovascular health to make the medical body and the community in general aware of the possible impact that the use of cannabis may have on the heart and cardiovascular system of the people who use it for medical and non-medical reasons.
Through its analysis, this important organization recognizes that, although some studies suggest that cannabinoids such as THC, whether of natural or synthetic origin, seem to have therapeutic effects in the management of chronic pain, spasticity related to neurological diseases, nausea, and vomiting by chemotherapy, and in the case of CBD, in the treatment of refractory epilepsy in children, no compound from the cannabis plant seems to have shown beneficial effects on the cardiovascular system to date. There is evidence from laboratory studies that CBD, a cannabinoid not present in high amounts in cannabis plant varieties in Colombia, could reduce inflammation in models of diabetic vascular disease, but this has not been translated into human studies.
The concern about the possible harmful effects of cannabis on heart health is more prominent today, given that with the recent legislative changes worldwide, there has been a change in the perception of damage that this substance could cause. As a result, although not very pronounced, an increase in consumption has been seen in adults and older adults, who tend to have underlying cardiac pathologies. In addition, amid experimentation with psychoactive substances, young people look for products with high amounts of THC, predisposing them to adverse cardiovascular effects.
Epidemiological studies show some signs that the use of cannabis could have some deleterious effect on cardiovascular function or on the risk of presenting cardiovascular disease. Increased visits to emergency services have been observed in US states where cannabis is legal due to acute myocardial infarctions and other adverse effects related to cannabis; case reports and observational studies show a temporal relationship between the use of cannabis and cases of arrhythmia and acute myocardial infarction in young men without a history of underlying heart disease. Cannabis exposure has been associated with instances of stroke and an elevated risk for stroke in cannabis users in the past year,
Given the known effects of delta-9-tetrahydrocannabinol on the cardiovascular system, such as stimulation of cardiac electrical activity, increased heart rate, increased oxygen demand of the heart muscle, impact on blood pressure, the use of this substance by older adults with cardiovascular disease may pose additional risks. Observational studies suggest that the use of cannabis can be a trigger for acute myocardial infarction since its consumption, particularly as a fuel, decreases the supply of oxygen to the myocardium, according to the authors of the AHA report. In older adults and those with diagnosed cardiovascular disease,
In the clinical context, for a person who might be a candidate for using cannabinoids therapeutically, the risks listed in the AHA report must be weighed against the potential benefit, as with any other medication. This is where it is essential to know the composition of the cannabis-based medical product so that this risk/benefit balance can be made as thoroughly as possible by a physician with sufficient knowledge of the subject and through a discussion that considers the therapeutic objectives of the patient. It is impossible to do this with artisanal products from the gray market, often contaminated or adulterated. They do not have a specific analysis to determine their exact dosage.
Regarding the adult use of cannabis, people should be able to decide whether or not to use this psychoactive substance. Still, unfortunately, the products on the illegal market never come with a report on the content of active substances in the plant. Generally, the genetics of the cannabis plant that has been in the Colombian environment produce high amounts of THC. In the same way, they have the risk of adulteration or contamination. Therefore, for adults, making use of their autonomy, to make an informed decision regarding the use of cannabis, this substance must be regulated.
In our country, where medicinal cannabis has been legal since 2016, and where different bills seeking to regulate cannabis for adult use are currently being discussed, it is imperative that the entire community knows, from scientific, neutral, and unbiased information, the impact that the use of cannabis and cannabinoids could have on your health.