Marijuana (Cannabis) Use is Independent Predictor of Broken Heart Syndrome in Younger Men Interview with:

Amitoj Singh MD Chief Cardiology Fellow St. Luke’s University Health Bethlehem, Pennsylvania

Dr. Amitoj Singh

Amitoj Singh MD
Chief Cardiology Fellow
St. Luke’s University Health
Bethlehem, Pennsylvania What is the background for this study?

Response: Marijuana use in steadily increasing and it is the most commonly used illicit drug in the US and worldwide. There has been a recent increase in reports of heart and vascular complications associated with its use. These include Myocardial infarctions, stroke and takotsubo.

We had two questions that we wanted to answer with our study:

a) Is there an association between marijuana use and development of Transient Regional Ventricular Ballooning [TVRB] (aka Stress Cardiomyopathy /Broken Heart Syndrome/ Takotsubo)?

b) If the above is true, what are the differences between Marijuana users (MU) and Non Marijuana Users (NMU) who developed Stress Cardiomyopathy. What are the main findings?
Response: Main findings of the study:

a) Multivariable logistic regression using marijuana user and 14 other covariates proved that marijuana use was independently associated with development of TVRB. [OR=1.994 (95% CI=1.716-2.317), p<0.0001]. This relationship was stronger when the logistic regression was applied to the 15-54 years age group, further validating our findings. [OR=2.389 (95% CI=2.004-2.848), p><0.0001]

b) On comparing TVRB patients with and without marijuana use, the marijuana users were considerably younger (44±14-vs-66±13 years) and were more often males (36%-vs-8%) [p><0.001 for both]. This is surprising as TVRB is usually a disease of older post-menopausal women.

c) Despite the younger age and less prevalence of traditional cardiovascular risk factors like hypertension, diabetes hyperlipidemia, marijuana users had higher incidence of in hospital cardiac arrest (2.4%-vs-0.8%) [p=0.011] and implantable cardioverter defibrillator (ICD) use (2.4%-vs-0.6%) [p=0.008].

d) There was a statistically significant increase in TVRB admissions related to marijuana use from 2003-2011 in the US. [OR=1.520 (95% CI=1.403-1.647), p><0.0001]. What should readers take away from your report?

Response: The Main take away points are the following:

a_ Active marijuana use doubles the risk of takotsubo (stress cardiomyopathy) especially in younger men

b) Takotsubo in such a setting is associated with significant morbidity despite the young age and more favorable cardiac risk factor profile of the affected individuals

c) Careful assessment of potential health risks of recreational Marijuana use is required at a time that legalization has occurred in some and is being considered in some states What recommendations do you have for future research as a result of this study?

a) Ours is a retrospective study and so, even though we have shown a correlation between marijuana use and TVRB, we cannot establish causality. Prospective studies should be performed and will be able to better understand this clinical question.

b) Genetic and Pharmacodynamic studies should look at how marijuana may be differently metabolized by a certain population of users and predispose them to higher risk of untoward cardiovascular events. Is there anything else you would like to add?

Response: In the past few years, mixed messages from the scientific community about the medical effects and safety of cannabinoids has led to confusion amongst the general population and treating physicians. This has resulted in painting a picture of innocence for cannabinoids and has allowed exploitation by the increasingly powerful marijuana industry/lobby. Our paper does not discount the beneficial effects of marijuana that have been reported in literature but at the same time cautions clinicians, researchers and most importantly the common masses that marijuana use is not without untoward effects, (particularly cardiac) some of which may be serious.

Limitations of the study:

a)This is not a randomized study

b)Frequency of use in those who were using Marijuana isn’t known

c)Route of use- oral or inhalation- not known

d) Time between use and hospitalization was not known. Thank you for your contribution to the community.


2016 Scientific Session of the American Heart Association -Abstract 14100:
Marijuana (Cannabis) Use is an Independent Predictor of Stress Cardiomyopathy in Younger Men

Amitoj Singh, Sahil Agrawal, Mark Fegley, Yugandhar Manda, Sudip Nanda and J
amshid Shirani
Circulation. 2016;134:A14100

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 14, 2016 by Marie Benz MD FAAD