(Circulation. 2001;103:2805.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Triggering Myocardial Infarction by Marijuana
From the Institute for the Prevention of Cardiovascular Disease, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School (M.A.M., R.A.L.); the Department of Epidemiology (M.A.M., M.M.) and the Department of Health and Social Behavior (J.B.S.), Harvard School of Public Health; and the Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School (J.E.M.), Boston, Mass.
Correspondence to Murray A. Mittleman, MD, DrPH, Cardiovascular Division, Beth Israel Deaconess Medical Center, 1 Autumn Street, Fifth Floor, Boston, MA 02215. E-mail mmittlem{at}caregroup.harvard.edu
Background—Marijuana use in the age group prone to coronary artery disease is higher than it was in the past. Smoking marijuana is known to have hemodynamic consequences, including a dose-dependent increase in heart rate, supine hypertension, and postural hypotension; however, whether it can trigger the onset of myocardial infarction is unknown.
Methods and Results—In the Determinants of Myocardial Infarction Onset Study, we interviewed 3882 patients (1258 women) with acute myocardial infarction an average of 4 days after infarction onset. We used the case-crossover study design to compare the reported use of marijuana in the hour preceding symptoms of myocardial infarction onset to its expected frequency using self-matched control data. Of the 3882 patients, 124 (3.2%) reported smoking marijuana in the prior year, 37 within 24 hours and 9 within 1 hour of myocardial infarction symptoms. Compared with nonusers, marijuana users were more likely to be men (94% versus 67%, P<0.001), current cigarette smokers (68% versus 32%, P<0.001), and obese (43% versus 32%, P=0.008). They were less likely to have a history of angina (12% versus 25%, P<0.001) or hypertension (30% versus 44%, P=0.002). The risk of myocardial infarction onset was elevated 4.8 times over baseline (95% confidence interval, 2.4 to 9.5) in the 60 minutes after marijuana use. The elevated risk rapidly decreased thereafter.
Conclusions—Smoking marijuana is a rare trigger of acute myocardial infarction. Understanding the mechanism through which marijuana causes infarction may provide insight into the triggering of myocardial infarction by this and other, more common stressors.
Key Words: cannabis • myocardial infarction • epidemiology • cross-over studies
This article has been cited by other articles:
 |
|
 |
|
  M. J. Seamon, J. A. Fass, M. Maniscalco-Feichtl, and N. A. Abu-Shraie Medical marijuana and the developing role of the pharmacist Am. J. Health Syst. Pharm., May 15, 2007; 64(10): 1037 - 1044. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Ornato, J. E. Muller, E. S. Froelicher, and R. A. Kloner Task Force II: Indirect and Secondary Cardiovascular Effects of Biological Terrorism Agents and Diseases J. Am. Coll. Cardiol., March 27, 2007; 49(12): 1389 - 1397. [Full Text] [PDF]
|
|
|
|
 |
|
 G. H. Tofler and J. E. Muller Triggering of Acute Cardiovascular Disease and Potential Preventive Strategies Circulation, October 24, 2006; 114(17): 1863 - 1872. [Full Text] [PDF]
|
|
|
|
 |
|
 A Zeka, A Zanobetti, and J Schwartz Short term effects of particulate matter on cause specific mortality: effects of lags and modification by city characteristics Occup. Environ. Med., October 1, 2005; 62(10): 718 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B A C Fisher, A Ghuran, V Vadamalai, and T F Antonios Cardiovascular complications induced by cannabis smoking: a case report and review of the literature Emerg. Med. J., September 1, 2005; 22(9): 679 - 680. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. de Jong, F. K. Engels, R. H.J. Mathijssen, L. van Zuylen, J. Verweij, R. P.H. Peters, and A. Sparreboom Medicinal Cannabis in Oncology Practice: Still a Bridge Too Far? J. Clin. Oncol., May 1, 2005; 23(13): 2886 - 2891. [Full Text] [PDF]
|
|
|
|
 |
|
 I Mateo, A Pinedo, M Gomez-Beldarrain, J M Basterretxea, and J C Garcia-Monco Recurrent stroke associated with cannabis use J. Neurol. Neurosurg. Psychiatry, March 1, 2005; 76(3): 435 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Moller, T. Theorell, U. de Faire, A. Ahlbom, and J. Hallqvist Work related stressful life events and the risk of myocardial infarction. Case-control and case-crossover analyses within the Stockholm heart epidemiology programme (SHEEP) J. Epidemiol. Community Health, January 1, 2005; 59(1): 23 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Peters, S. von Klot, M. Heier, I. Trentinaglia, A. Hormann, H. E. Wichmann, H. Lowel, and the Cooperative Health Research in the Region of A Exposure to Traffic and the Onset of Myocardial Infarction N. Engl. J. Med., October 21, 2004; 351(17): 1721 - 1730. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Deusch, H. G. Kress, B. Kraft, and S. A. Kozek-Langenecker The Procoagulatory Effects of Delta-9-Tetrahydrocannabinol in Human Platelets Anesth. Analg., October 1, 2004; 99(4): 1127 - 1130. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. M. Compton, B. F. Grant, J. D. Colliver, M. D. Glantz, and F. S. Stinson Prevalence of Marijuana Use Disorders in the United States: 1991-1992 and 2001-2002 JAMA, May 5, 2004; 291(17): 2114 - 2121. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Varadhan and C. E. Frangakis Revealing and Addressing Length Bias and Heterogeneous Effects in Frequency Case-Crossover Studies Am. J. Epidemiol., March 15, 2004; 159(6): 596 - 602. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sidney Comparing cannabis with tobacco--again BMJ, September 20, 2003; 327(7416): 635 - 636. [Full Text] [PDF]
|
|
|
|
|
|
J. A Henry, W. L G Oldfield, and O. M. Kon Comparing cannabis with tobacco BMJ, May 3, 2003; 326(7396): 942 - 943. [Full Text] [PDF]
|
|
|
|
|
|
P. K. Shah Mechanisms of plaque vulnerability and rupture J. Am. Coll. Cardiol., February 19, 2003; 41(4_Suppl_S): 15S - 22S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Ghuran, L R van der Wieken, and J Nolan Cardiovascular complications of recreational drugs BMJ, September 1, 2001; 323(7311): 464 - 466. [Full Text] [PDF]
|
|
|
|
 |
|
 Marijuana Use May Be Temporally Related to MI Journal Watch Cardiology, August 31, 2001; 2001(831): 11 - 11. [Full Text]
|
|