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Cannabis for Chronic Pain: CV Safety Study
Quick Takes
- Use of medical cannabis was associated with an increased risk for new-onset arrhythmias compared with no use.
- An increased risk of new-onset atrial fibrillation/flutter was associated with medical cannabis use.
- Use of medical cannabis was not associated with an increased risk for acute coronary syndrome.
Study Questions:
Is medical-related use of cannabis associated with cardiovascular (CV) side effects?
Methods:
Data from nationwide Danish registers were used for the present analysis. Patients aged ≥18 years with a diagnosis of chronic pain or a disorder linked to chronic pain (arthritis, back-related pain, disc-related pain, complicated fractures, cancer, neurological disease, headaches, and other unspecified pain diagnoses) during the years 2013–2021 were included. Patients with a claimed prescription of medical cannabis before inclusion or with a history of arrhythmia were excluded. The control group was matched 1:5 on age, sex, chronic pain diagnosis, and concomitant use of noncannabis pain medications, and no prior use of medical cannabis or prior history of arrhythmia. The primary outcome of interest was new-onset arrhythmia, defined as hospitalization or outpatient visit with a primary or secondary diagnosis of atrial fibrillation/flutter, conduction disorders, paroxysmal tachycardias, or ventricular arrhythmias.
Results:
A total of 1,882,732 patients (mean age 55 years, 54% women) were included in the final cohort, of which 5,391 used medical cannabis (47% tetrahydrocannabinol [THC] use, 29% THC/cannabidiol [CBD] use, and 24% CBD use) during 2018–2021 and 26,941 were the matched controls. Among the cohort, chronic pain diagnosis included 46% musculoskeletal related, 11% cancer related, 13% neurological related, and 30% were unspecified pain. New-onset arrhythmias were observed in 42 cases and 107 controls within 180 days. Medical cannabis use was associated with a risk ratio (RR) of 2.07 (95% confidence interval [Cl], 1.34-2.80) at 180 days and a 1-year RR of 1.36 (95% Cl, 1.00-1.73). The 180-day absolute risk was 0.8% (95% Cl, 0.6%-1.1 %) compared with no use (180-day absolute risk, 0.4%; 95% Cl, 0.3-0.5%). Medical cannabis use was associated with an increased risk for new-onset atrial fibrillation/flutter (RR, 2.04; 95% CI, 1.19-2.98). No significant association was found for acute coronary syndrome.
Conclusions:
The authors conclude that in patients with chronic pain, the use of prescribed medical cannabis was associated with an elevated risk of new-onset arrhythmia compared with no use—most pronounced in the 180 days following the initiation of treatment.
Perspective:
Data from a large national registry suggest that use of medical cannabis is associated with an increased risk of new-onset arrhythmia including atrial fibrillation/flutter. These data will assist providers and patients in making decisions on use of medical cannabis for pain management. However, data on diverse populations are warranted to confirm generalizability of these findings.
Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Prevention
Keywords: Arrhythmias, Cardiac, Cannabis, Chronic Pain
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