Cardiovascular Toxicity Associated With Medical Cannabinoid Use: A Systematic Review and Meta-Analysis

The medical and recreational use of cannabis and cannabinoids has increased significantly since its legalization. It was estimated that 3.8% of the global adult population of about 188 million people use cannabis or cannabinoids, which results in cannabis or cannabinoids as the most commonly used illicit drugs. Public campaigns to legalize its use have been ongoing for decades, however, its success has become apparent recently. Currently in the United States, Marijuana is legal for adults over the age of 21 in 11 states and 33 states accept it for medical usage. With the legalization and increase in its use, the personal and public health concerns are increasing among the medical community. Studies have shown that smoking marijuana can cause micro and macroscopic injury to airways. However, there was no clear association between cannabis or cannabinoids use and development of chronic obstructive pulmonary disease. When looking at the association between cannabis usage and cancer development, studies have not shown any strong association between its use and cancer. There was no association between cannabis usage and development of head and neck or lung cancer. Interestingly, meta-analysis found slight increased risk of testicular cancer. As heart disease is the leading cause of death for men and women in the United States, it is critical to look at cardiovascular effects of Cannabis or Cannabinoids. When looking at cardiovascular effects of Cannabis, animal and in vitro studies demonstrated that Δ9-tetrahydrocannabinol (THC) can interact with cannabinoid receptors on human cardiomyocytes and vascular smooth muscles. Case series and case control studies have suggested the possible association between cannabis use in patients and development of myocardial infarction. However, the comprehensive review and meta-analysis of the cardiovascular effect from cannabis is lacking. Given the lack of this informative evidence, we conducted a systematic review and meta-analysis to evaluate the evidence of cardiovascular effect/toxicity on cannabis and cannabinoids