Chetty Kimesh, Lavoie Andrea, Deghani Payam
University of Calgary, Calgary, Alberta, Canada.
Department of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
CJC Open. 2020 Sep 3;3(1):12-21. doi: 10.1016/j.cjco.2020.09.001. eCollection 2021 Jan.
Increasing legalization and expanding medicinal use have led to a significant rise in global cannabis consumption. With this development, we have seen a growing number of case reports describing adverse cardiovascular events, specifically, cannabis-induced myocardial infarction (MI). However, there are considerable knowledge gaps on this topic among health care providers. This review aims to provide an up-to-date review of the current literature, as well as practical recommendations for clinicians. We also focus on proposed mechanisms implicating cannabis as a risk factor for MI. We performed a comprehensive literature search using the MEDLINE, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Turning Research into Practice (TRIP) PRO databases for articles published between 2000 and 2018. A total of 92 articles were included. We found a significant number of reports describing cannabis-induced MI. This was especially prevalent among young healthy patients, presenting shortly after use. The most commonly proposed mechanisms included increased autonomic stimulation, altered platelet function, vasospasm, and direct toxic effects of smoke constituents. However, it is likely that the true pathogenesis is multifactorial. We should increase our pretest probability for MI in young patients presenting with chest pain. We also recommend against cannabis use in patients with known coronary artery disease, especially if they have stable angina. Finally, if patients are adamant about using cannabis, health care providers should recommend against smoking cannabis, avoidance of concomitant tobacco use, and use of the lowest delta-9-tetrahydrocannabinol dose possible. Data quality is limited to that of observational studies and case report data. Therefore, more clinical trials are needed to determine a definitive cause-and-effect relationship.
大麻合法化程度的提高及其药用范围的扩大导致全球大麻消费量显著上升。随着这一发展，我们看到越来越多的病例报告描述了不良心血管事件，特别是大麻诱发的心肌梗死（MI）。然而，医疗保健提供者在这个问题上存在相当大的知识空白。本综述旨在对当前文献进行最新回顾，并为临床医生提供实用建议。我们还关注了将大麻视为心肌梗死风险因素的潜在机制。我们使用MEDLINE、Cochrane、护理学与健康相关文献累积索引（CINAHL）以及将研究转化为实践（TRIP）PRO数据库，对2000年至2018年发表的文章进行了全面的文献检索。共纳入92篇文章。我们发现大量报告描述了大麻诱发的心肌梗死。这在年轻健康患者中尤为普遍，在使用后不久就会出现。最常提出的机制包括自主神经刺激增加、血小板功能改变、血管痉挛以及烟雾成分的直接毒性作用。然而，真正的发病机制可能是多因素的。对于出现胸痛的年轻患者，我们应提高心肌梗死的预测试概率。我们还建议已知患有冠状动脉疾病的患者不要使用大麻，尤其是那些患有稳定型心绞痛的患者。最后，如果患者坚决要使用大麻，医疗保健提供者应建议不要吸食大麻，避免同时使用烟草，并尽可能使用最低剂量的Δ⁹ - 四氢大麻酚。数据质量仅限于观察性研究和病例报告数据。因此，需要更多的临床试验来确定明确的因果关系。
