Service de Médecine légale, Groupe Hospitalier Universitaires AP-HP.Paris-Saclay, hôpital Raymond Poincaré, 104 bvd R. Poincaré, 92380, Garches, France.
Service de Pharmacologie-Toxicologie, Hôpital Raymond Poincaré, Groupe Hospitalier Universitaires AP-HP.Paris-Saclay, 92380, Garches, France.
Int J Legal Med. 2023 Nov;137(6):1725-1733. doi: 10.1007/s00414-023-03079-x. Epub 2023 Aug 31.
The aim of this monocentric observational autopsy study was to confirm the existence of a link between cannabis use and cardiovascular risk. It was based on the analysis of autopsy findings, cardiovascular pathological findings, and toxicological data in 43 autopsy cases of people who died with tetrahydrocannabinol (THC) in their blood over a 2-year period. Hair analysis was performed when available (n = 40) to distinguish between occasional and chronic cannabis use and to take into account other possible exposures, including smoking, drug consumption, and the use of other drugs of abuse (mainly cocaine, heroin, and amphetamine). A statistically significant association (Fisher's exact test, p < 0.001) was found between cannabis use, an undetermined manner of death, and the presence of an arrhythmogenic cardiac condition. An association was also found between cannabis use and the presence of advanced coronary heart disease (p = 0.01), heart disease (including ischemic heart disease, p = 0.003), or cardiomyopathy (p = 0.01). Through its systemic vascular action, cannabis could be a factor in triggering sudden death in subjects with arrhythmogenic cardiac conditions. In view of this finding, the mode of death of subjects who died in the presence of THC in the blood would in most cases be an "accident." These results highlight the potential adverse cardiac effects associated with cannabis use.
这项单中心观察性尸检研究的目的是确认大麻使用与心血管风险之间存在关联。它基于对在两年期间血液中含有四氢大麻酚 (THC) 的 43 例尸检病例的尸检结果、心血管病理学发现和毒理学数据的分析。当有头发分析可用时（n = 40），会区分偶尔和慢性大麻使用，并考虑其他可能的暴露，包括吸烟、药物使用和其他药物滥用（主要是可卡因、海洛因和安非他命）。在大麻使用、原因不明的死亡方式和心律失常性心脏状况的存在之间发现了统计学上显著的关联（Fisher 确切检验，p < 0.001）。大麻使用与晚期冠心病（p = 0.01）、心脏病（包括缺血性心脏病，p = 0.003）或心肌病（p = 0.01）的存在之间也存在关联。大麻通过其全身血管作用，可能是引发心律失常性心脏状况患者猝死的一个因素。鉴于这一发现，在血液中存在 THC 的情况下死亡的受试者的死亡方式在大多数情况下将是“意外”。这些结果强调了与大麻使用相关的潜在不良心脏影响。
