humulene and Coronary-Artery-Disease

Marijuana is the most abused recreational drug in the United States. Cannabinoids, the active ingredients of marijuana, affect multiple organ systems in the human body. The pharmacologic effects of marijuana, based on stimulation of cannabinoid receptors CB1 and CB2, which are widely distributed in the cardiovascular system, have been well described. Activation of these receptors modulates the function of various cellular elements of the vessel wall, and may contribute to the pathogenesis of atherosclerosis. Clinically, there are reports linking marijuana smoking to the precipitation of angina and acute coronary syndromes. Recently, large published clinical trials with CB1 antagonist rimonabant did not show any significant benefit of this agent in preventing progression of atherosclerosis. In light of these findings and emerging data on multiple pathways linking cannabinoids to atherosclerosis, we discuss the literature on the role of cannabinoids in the pathophysiology of atherosclerosis. We also propose a marijuana paradox, which implies that inhalation of marijuana may be linked to precipitation of acute coronary syndromes, but modulation of the endocannabinoid system by a noninhalation route may have a salutary effect on the development of atherosclerosis.

Topics: Cannabinoids; Cannabis; Coronary Artery Disease; Coronary Vessels; Endothelium, Vascular; Humans; Inflammation; Lipid Metabolism; United States

BACKGROUND Myocardial infarction (MI) is one of the most ominous medical emergencies because it carries significant morbidity and mortality. A myocardial bridge is an anomaly previously perceived as benign. However, with a better understanding, it is considered a risk factor for angina and MI in some cases. Certain precipitating factors potentiate the coronary artery within the myocardial bridge to having vasospasms. Cannabis is one of many potential precipitants for vasospasm in the setting of a myocardial bridge because it increases vascular tone and increases sympathetic hormone secretion in the form of noradrenaline. CASE REPORT We report a case of a 31-year-old man presenting with myocardial infarction, without any known traditional risk factors for cardiovascular disease. Upon investigation, we discovered that he had an underlying myocardial bridge, which in the setting of significant cannabis consumption, precipitated myocardial infarction with non-obstructive coronary arteries (MINOCA) disease on invasive angiography. CONCLUSIONS In a setting with an underlying risk factor or cardiac anomaly, cannabis can induce an MI and potentially other adverse cardiac complications. With the increasing use of cannabis in several regions of the world, more adverse events outside of the well-documented psychotropic effects of cannabis are anticipated. Therefore, clinicians need to bear in mind the multifaceted effects of adverse events from cannabis in the various organ systems and be prepared to ensure prompt treatment as needed. Given the nature of the pathophysiology of MINOCA in a patient with a myocardial bridge, it is paramount to be aware that the cause of infarction is a reversible one.

Topics: Adult; Cannabis; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Humans; Male; MINOCA; Myocardial Infarction; Risk Factors; Vascular Diseases

Cannabis is associated with risk of acute coronary syndrome in observational studies. However, its association with prevalent coronary artery disease (CAD) remains unclear. We hypothesized that cannabis use is associated with prevalent CAD.. This analysis included 12,543 participants (age 39.3 ± 11.6 years, 48.8% male, 35.3% Caucasians) from The National Health and Nutrition Examination Survey (NHANES). Cannabis use was self-reported. Prevalent CAD was defined by physician diagnosis. The association between cannabis use and CAD was tested for using multivariable logistic regression.. About 53.1% (n = 6,650) of participants were ever cannabis users and 1.1% (n = 137) had prevalent CAD. Ever (versus never) cannabis users had 90% increased odds of CAD [OR (95% CI): 1.90 (1.24 - 2.93), p = 0.003]. Those who had used cannabis at least once per month for at least one year had 68% increased odds of CAD [OR (95% CI): 1.68 (1.02-2.77), p = 0.04]. Current cannabis users had near 98% increased odds of CAD [OR (95% CI): 1.98 (1.11 - 3.54), p = 0.02]. Similar results were seen with heavy cannabis users [OR (95% CI): 1.99 (1.02 - 3.89), p = 0.045]. These results were consistent in subgroups stratified by race, gender, hypertension, obesity, COPD, hyperlipidemia, tobacco smoking status, and diabetes.. Cannabis use is associated with prevalent CAD. This finding emphasizes the potential harmful effects of cannabis use on cardiovascular health and highlights the need for further research as it becomes more accepted at both a national and global level.

Topics: Adult; Cannabis; Coronary Artery Disease; Female; Humans; Logistic Models; Male; Middle Aged; Nutrition Surveys; Risk Factors

Cannabis is the most widely trafficked and abused illicit drug due to its calming psychoactive properties. It has been increasingly recognized as having potential health benefits and relatively less adverse health effects as compared to other illicit drugs; however, growing evidence clearly indicates that cannabis is associated with considerable adverse cardiovascular events. Recent studies have linked cannabis use to myocardial infarction (MI); yet, very little is known about the underlying mechanisms. A MI is a cardiovascular disease characterized by a mismatch in the oxygen supply and demand of the heart, resulting in ischemia and subsequent necrosis of the myocardium. Since cannabis is increasingly being considered a risk factor for MI, there is a growing need for better appreciating its potential health benefits and consequences. Here, we discuss the cellular mechanisms of cannabis that lead to an increased risk of MI. We provide a thorough and critical analysis of cannabinoids' actions, which include modulation of adipocyte biology, regional fat distribution, and atherosclerosis, as well as precipitation of hemodynamic stressors relevant in the setting of a MI. By critically dissecting the modulation of signaling pathways in multiple cell types, this paper highlights the mechanisms through which cannabis may trigger life-threatening cardiovascular events. This then provides a framework for future pharmacological studies which can identify targets or develop drugs that modulate cannabis' effects on the cardiovascular system as well as other organ systems. Cannabis' impact on the autonomic outflow, vascular smooth muscle cells, myocardium, cortisol levels and other hemodynamic changes are also mechanistically reviewed.

Topics: Analgesics; Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Coronary Artery Disease; Humans; Myocardial Infarction

Topics: Cannabis; Cognition; Coronary Artery Disease; Drug Users; Executive Function; Female; Humans; Male; Memory

Marijuana use is increasingly common in the United States. It is unclear whether it has long-term effects on memory and other domains of cognitive function.. To study the association between cumulative lifetime exposure to marijuana use and cognitive performance in middle age.. We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of 5115 black and white men and women aged 18 to 30 years at baseline from March 25, 1985, to June 7, 1986 (year 0), and followed up over 25 years from June 7, 1986, to August 31, 2011, to estimate cumulative years of exposure to marijuana (1 year = 365 days of marijuana use) using repeated measures and to assess associations with cognitive function at year 25. Linear regression was used to adjust for demographic factors, cardiovascular risk factors, tobacco smoking, use of alcohol and illicit drugs, physical activity, depression, and results of the mirror star tracing test (a measure of cognitive function) at year 2. Data analysis was conducted from June 7, 1986, to August 31, 2011.. Three domains of cognitive function were assessed at year 25 using the Rey Auditory Verbal Learning Test (verbal memory), the Digit Symbol Substitution Test (processing speed), and the Stroop Interference Test (executive function).. Among 3385 participants with cognitive function measurements at the year 25 visit, 2852 (84.3%) reported past marijuana use, but only 392 (11.6%) continued to use marijuana into middle age. Current use of marijuana was associated with worse verbal memory and processing speed; cumulative lifetime exposure was associated with worse performance in all 3 domains of cognitive function. After excluding current users and adjusting for potential confounders, cumulative lifetime exposure to marijuana remained significantly associated with worse verbal memory. For each 5 years of past exposure, verbal memory was 0.13 standardized units lower (95% CI, -0.24 to -0.02; P = .02), corresponding to a mean of 1 of 2 participants remembering 1 word fewer from a list of 15 words for every 5 years of use. After adjustment, we found no associations with lower executive function (-0.03 [95% CI, -0.12 to 0.07]; P = .56) or processing speed (-0.04 [95% CI, -0.16 to 0.08]; P = .51).. Past exposure to marijuana is associated with worse verbal memory but does not appear to affect other domains of cognitive function.

Topics: Adult; Cannabis; Cognition; Coronary Artery Disease; Drug Users; Executive Function; Female; Humans; Longitudinal Studies; Male; Memory; Middle Aged; Risk Factors; United States; Verbal Learning; Young Adult

Topics: Cannabis; Cognition; Coronary Artery Disease; Drug Users; Executive Function; Female; Humans; Male; Memory

Topics: Cannabis; Cognition; Coronary Artery Disease; Drug Users; Executive Function; Female; Humans; Male; Memory

Topics: Acute Coronary Syndrome; Adult; Cannabis; Chest Pain; Cholesterol; Coronary Angiography; Coronary Artery Disease; Diagnosis, Differential; Dyslipidemias; Humans; Male

Cannabis smoking is on the increase both in the United Kingdom and in the United States. For over three decades it has been known that cannabis has pathophysiological effects on the cardiovascular system, and previously an association with an increased risk of myocardial infarction has been reported. However, it is not yet known whether cannabis contributes directly to coronary artery disease. We describe two distinct cases; in the first cannabis use precipitated a malignant arrhythmia in a patient with critical ischaemia from longstanding coronary artery disease. In the second, a young patient presented with an acute myocardial infarction that had started whilst smoking marijuana; subsequently diffuse coronary artery disease was found at angiography despite the patient's low risk factor status. Patients who are known cannabis smokers and who have cardiovascular disease should be warned that it is likely to aggravate coronary ischaemia, and may even trigger myocardial infarction.

Topics: Adult; Arrhythmias, Cardiac; Cannabis; Cardiovascular System; Coronary Angiography; Coronary Artery Disease; Humans; Male; Middle Aged; Myocardial Ischemia; Phytotherapy; Plant Preparations