Marijuana use and long-term mortality among survivors of acute myocardial infarction
Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA American heart journal
(Impact Factor: 4.46).
02/2013; 165(2):170-5. DOI: 10.1016/j.ahj.2012.11.007
Smoking marijuana has been reported to increase risk of myocardial infarction (MI) immediately after use, but less is known about the long-term impact of marijuana use among patients with established coronary disease.
The Determinants of MI Onset Study is a multicenter inception cohort study of myocardial infarction (MI) patients enrolled in 1989 to 1996 and followed up for mortality using the National Death Index. In an initial analysis of 1,935 MI survivors followed up for a median of 3.8 years, we found an increased mortality rate among marijuana users. The current article includes 3,886 Determinants of MI Onset Study patients followed up for up to 18 years. We used Cox proportional hazards models to calculate the hazard ratio and 95% CI for the association between marijuana use and mortality and a propensity score matched analysis to further control confounding.
Over up to 18 years of follow-up, 519 patients died, including 22 of the 109 reporting marijuana use in the year before their MI. There was no statistically significant association between marijuana use and mortality. Compared with nonusers, the mortality rate was 29% higher (95% CI 0.81-2.05, P = .28) among those reporting any marijuana use.
Habitual marijuana use among patients presenting with acute MI was associated with an apparent increased mortality rate over the following 18 years that did not reach nominal statistical significance. Larger studies with repeated measures of marijuana use are needed to definitively establish whether there are adverse cardiovascular consequences of smoking marijuana among patients with established coronary heart disease.
Available from: Pal Pacher
[Show abstract] [Hide abstract]
ABSTRACT: The discovery of the endocannabinoid system (ECS; comprising of G-protein coupled cannabinoid 1 and 2 receptors, their endogenous lipid ligands or endocannabinoids, and synthetic and metabolizing enzymes, triggered an avalanche of experimental studies that have implicated the ECS in a growing number of physiological/pathological functions. They also suggested that modulating ECS activity holds therapeutic promise for a broad range of diseases, including neurodegenerative, cardiovascular and inflammatory disorders, obesity/metabolic syndrome, cachexia, chemotherapy-induced nausea and vomiting, tissue injury and pain, among others. However, clinical trials with globally acting CB1 antagonists in obesity/metabolic syndrome, and other studies with peripherally restricted CB1/2 agonists and inhibitors of the endocannabinoid metabolizing enzyme in pain introduced unexpected complexities, and suggested that better understanding of the pathophysiological role of the ECS is required in order to devise clinically successful treatment strategies, which will be critically reviewed in this brief synopsis. Journal compilation © 2013 FEBS. No claim to original US government works.
FEBS Journal 04/2013; 280(9). DOI:10.1111/febs.12260 · 4.00 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Marijuana is the most widely used illicit drug, with approximately 200 million users worldwide. Once illegal throughout the United States, cannabis is now legal for medicinal purposes in several states and for recreational use in 3 states. The current wave of decriminalization may lead to more widespread use, and it is important that cardiologists be made aware of the potential for marijuana-associated adverse cardiovascular effects that may begin to occur in the population at a greater frequency. In this report, the investigators focus on the known cardiovascular, cerebrovascular, and peripheral effects of marijuana inhalation. Temporal associations between marijuana use and serious adverse events, including myocardial infarction, sudden cardiac death, cardiomyopathy, stroke, transient ischemic attack, and cannabis arteritis have been described. In conclusion, the potential for increased use of marijuana in the changing legal landscape suggests the need for the community to intensify research regarding the safety of marijuana use and for cardiologists to maintain an awareness of the potential for adverse effects.
The American journal of cardiology 10/2013; 113(1). DOI:10.1016/j.amjcard.2013.09.042 · 3.28 Impact Factor
Available from: Jean Lud Cadet
[Show abstract] [Hide abstract]
ABSTRACT: Addictions to licit and illicit drugs are chronic relapsing brain disorders that affect circuits that regulate reward, motivation, memory, and decision-making. Drug-induced pathological changes in these brain regions are associated with characteristic enduring behaviors that continue despite adverse biopsychosocial consequences. Repeated exposure to these substances leads to egocentric behaviors that focus on obtaining the drug by any means and on taking the drug under adverse psychosocial and medical conditions. Addiction also includes craving for the substances and, in some cases, involvement in risky behaviors that can cause death. These patterns of behaviors are associated with specific cognitive disturbances and neuroimaging evidence for brain dysfunctions in a diverse population of drug addicts. Postmortem studies have also revealed significant biochemical and/or structural abnormalities in some addicted individuals. The present review provides a summary of the evidence that has accumulated over the past few years to implicate brain dysfunctions in the varied manifestations of drug addiction. We thus review data on cerebrovascular alterations, brain structural abnormalities, and postmortem studies of patients who abuse cannabis, cocaine, amphetamines, heroin, and "bath salts". We also discuss potential molecular, biochemical, and cellular bases for the varied clinical presentations of these patients. Elucidation of the biological bases of addiction will help to develop better therapeutic approaches to these patient populations.
Acta Neuropathologica 11/2013; 127(1). DOI:10.1007/s00401-013-1221-7 · 10.76 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.