How Does Zika Virus, Marijuana and Erectile Dysfunction Drugs Impact CV Events?

New research exploring Zika-related cardiovascular complications, marijuana’s influence on stroke and heart failure (HF) and erectile dysfunction drugs’ impact on heart attack survivors made headlines in major news outlets during ACC.17.

Zika-Related Cardiovascular Complications

Results from a small case report led by Karina Gonzalez Carta, MD, suggest that the Zika virus may be linked to potentially harmful effects on the heart. The study followed nine patients who reported symptoms and were treated at the Institute of Tropical Medicine in Caracas, Venezuela. Of the nine patients treated, only one reported previous well-controlled high blood pressure, and two-thirds were women.

Beginning in July 2016, follow ups were conducted on a six-month basis. Eight of the nine patients with an active Zika infection had arrhythmias and six experienced HF (five with low ejection fraction). Since contracting the infection, the patients have yet to report resolved issues.

The study highlights the need to raise awareness about Zika’s possible link to cardiovascular complications, especially since the data show an average lag time of 10 days from patients’ initial reports of symptoms suggestive of heart problems. “It’s likely that many more people are affected,” Carta said. “We need larger, systematic studies to understand the actual risk of Zika-related cardiac problems and what makes one patient more prone to develop them.”

Marijuana Use and Stroke, HF

Medical and recreational marijuana use may be legal in more than half of U.S. states, but results from a recent study investigating cardiovascular outcomes found that it raises the risk of stroke and HF, even after accounting for demographic factors and additional lifestyle risk factors.

Study investigators found that use was not only associated with a 26 percent increase in the risk of stroke and 10 percent increase in developing HF, it also was linked to obesity, high blood pressure and smoking and alcohol use. Of the 20 million health records of young and middle-aged patients analyzed, marijuana use was diagnosed in 1.5 percent.

“More research will be needed to understand the pathophysiology behind this effect,” said Aditi Kalla, MD, the study’s lead author.

Erectile Dysfunction Drugs After MI

Men 80 years and younger prescribed erectile dysfunction drugs following a myocardial infarction were 33 percent less likely to die and 40 percent less likely to be hospitalized for HF than men who were not.

Study investigators analyzed the records of 43,000 patients from 2007 to 2013 using a Swedish national database. Of the 7 percent of men prescribed an erectile dysfunction drug, 92 filled prescriptions for phosphodiesterase-5 (PDE5) inhibitors, while 8 percent filled prescriptions for alprostadil.

The results came as a surprise for the study’s lead author, Daniel Peter Andersson, MD, PhD, due to previous associations with increased risk of cardiovascular disease in otherwise healthy men. “From the perspective of a doctor, if a patient asks about erectile dysfunction drugs after a [MI] and has no contraindications for PDE5 inhibitors, based on these results you can feel safe about prescribing it,” Andersson concludes.


Note: The editors-in-chief caution there are potential drug-drug interactions with marijuana, including an increase in the anticoagulant effect of warfarin, due to inhibition of its metabolism.

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Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Statins, Acute Heart Failure, Hypertension, Smoking

Keywords: ACC Publications, Cardiology Magazine, Alcohols, Alprostadil, Arrhythmias, Cardiac, Cannabis, Cyclic Nucleotide Phosphodiesterases, Type 5, Marijuana Smoking, Follow-Up Studies, Heart Failure, Hypertension, Middle Aged, Myocardial Infarction, Phosphodiesterase 5 Inhibitors, Research Personnel, Risk Factors, Smoking, Stroke, Virus Diseases


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