Storck Wilhelm, Elbaz Meyer, Vindis Cécile, Déguilhem Amélia, Lapeyre-Mestre Maryse, Jouanjus Emilie
CERPOP, University of Toulouse, Inserm, Toulouse, Occitanie, France.
Pharmacovigilance Center, Department of Hypertension, Vascular Disease and Clinical Pharmacology, Strasbourg Regional University Hospital, Strasbourg, Grand Est, France.
Heart. 2025 Jun 17. doi: 10.1136/heartjnl-2024-325429.
Awareness has recently risen about the potential associated risks to the cardiovascular health of cannabis users. The objective was to evaluate the possible association between major adverse cardiovascular events (MACE) and the use of cannabis or cannabinoids.
Original pharmacoepidemiological studies providing risk estimates on cannabis-related MACE (ie, cardiovascular death, non-fatal acute coronary syndrome (ACS) including myocardial infarction (MI) or non-fatal stroke) published from 1 January 2016 to 31 January 2023 were included in the systematic review exploring PubMed, Web of Science and Scopus (last search: 20 September 2023). Design, duration, baseline characteristics, exposure, inclusion criteria, sample size, effect size and confusing factors, including exposure to psychoactive substances, were extracted. Study quality was assessed using the ROBINS-E (risk of bias in non-randomised studies-of exposures) tool. In the meta-analysis, adjusted effect estimates and their 95% CIs were pooled using a DerSimonian and Laird random effect model with inverse variance weighting based on the type of outcome (PROSPERO: CRD42023401401).
Overall, 24 articles were included from 3012 initial records, including 17 cross-sectional studies, 6 cohort studies and 1 case-control study. Exposure corresponded to the use of cannabis in all studies, with one focused on medical cannabis. The estimated risk ratio (RR) was 1.29 (95% CI 1.05 to 1.59) for ACS, 1.20 (1.13 to 1.26) for stroke and 2.10 (1.29 to 3.42) for cardiovascular death. As measured in two studies, no statistically significant association was found for the composite outcome combining ACS and stroke. The focused analysis restricted to cohort studies yielded comparable results to the primary model (RR=1.32, 1.01 to 1.73).
This systematic review and meta-analysis uses an original approach centred on real-world data. The findings reveal positive associations between cannabis use and MACE. These findings should encourage investigating cannabis use in all patients presenting with serious cardiovascular disorders.
CRD42023401401.
近期，人们对大麻使用者心血管健康的潜在相关风险的认识有所提高。目的是评估主要不良心血管事件（MACE）与大麻或大麻素使用之间的可能关联。
在2016年1月1日至2023年1月31日期间发表的、提供与大麻相关的MACE（即心血管死亡、非致命性急性冠状动脉综合征（ACS），包括心肌梗死（MI）或非致命性中风）风险估计的原始药物流行病学研究被纳入本次系统评价，检索了PubMed、科学网和Scopus（最后一次检索时间：2023年9月20日）。提取研究设计、持续时间、基线特征、暴露情况、纳入标准、样本量、效应量和混杂因素，包括精神活性物质暴露情况。使用ROBINS-E（非随机暴露研究中的偏倚风险）工具评估研究质量。在荟萃分析中，根据结果类型，采用DerSimonian和Laird随机效应模型，以逆方差加权法汇总调整后的效应估计值及其95%置信区间（PROSPERO：CRD42023401401）。
总体而言，从3012条初始记录中纳入了24篇文章，包括17项横断面研究、6项队列研究和1项病例对照研究。所有研究中的暴露均对应于大麻的使用，其中一项研究聚焦于医用大麻。ACS的估计风险比（RR）为1.29（95%CI 1.05至1.59），中风为1.20（1.13至1.26），心血管死亡为2.10（1.29至3.42）。在两项研究中进行测量时，未发现ACS和中风合并的复合结局存在统计学显著关联。仅限于队列研究的重点分析得出了与主要模型相当的结果（RR = 1.32，1.01至1.73）。
本系统评价和荟萃分析采用了以真实世界数据为中心的原创方法。研究结果揭示了大麻使用与MACE之间的正相关关系。这些发现应促使对所有患有严重心血管疾病的患者的大麻使用情况进行调查。
PROSPERO注册号：CRD42023401401。
