As more states legalize marijuana for both medicinal and recreational use and use increases nationwide, cardiologists should advise patients about the potential risks, including effects of marijuana with some commonly prescribed cardiovascular medications, according to a review paper published Jan. 20 in the Journal of the American College of Cardiology.

Muthiah Vaduganathan, MD, MPH, et al., estimate that more than 2 million cardiovascular disease patients are currently using marijuana or have used marijuana previously. This includes recreational use and approved medical uses. Marijuana is becoming increasingly more potent and carries many of the same cardiovascular health hazards as smoking tobacco. According to the paper, certain cardiovascular medications, including statins and blood thinners, can be affected by marijuana use.

The authors recommend that cardiologists screen their patients for marijuana use, asking them how often and how much they use. They also should ask about how they use marijuana. For patients who wish to continue to use marijuana, or who have other medically indicated reasons for use, the reviewers recommend limiting use as much as possible and for clinicians to inform patients that vaping and certain synthetic forms of cannabinoids are particularly potent and may have greater adverse effects. Some patients, such as those considered for heart transplantation or those who present with early-onset myocardial infarction or heart failure at a young age, should be screened for marijuana use.

The review provides detailed tables of many drugs administered for various cardiovascular conditions, with the anticipated effects of marijuana on each one. These can be used by caregivers to decide whether they need to adjust dosing if the patient continues to use marijuana.

Data on the exact health effects of marijuana on the cardiovascular system are limited, largely because federal laws that classify marijuana as a Schedule I drug have limited the ability of scientists to conduct high-quality research.

"Now that we have seen marijuana use become more popular than tobacco smoking, we need more rigorous research, including randomized clinical trials, to explore the effects of marijuana on cardiovascular health," Vaduganathan said.

Clinical Topics: Cardiac Surgery, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Heart Failure, Nonstatins, Novel Agents, Statins, Acute Heart Failure, Heart Transplant, Smoking

Keywords: Cannabis, Cannabinoids, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Marijuana Smoking, Marijuana Abuse, Medical Marijuana, Tobacco, Tobacco Use, Heart Transplantation, Heart Failure, Myocardial Infarction, Electronic Nicotine Delivery Systems

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