Cannabis and other drugs associated with increased risk

Cannabis and other drugs associated with increased risk

A nurse checks a heart rate monitor in a hospitalShare on Pinterest
A study found a link between the use of methamphetamine, cocaine, opiates and cannabis and the development of atrial fibrillation (AFib). Bernd Wüstneck/picture alliance via Getty Images
  • An observational study found an association between the use of methamphetamine, cocaine, opiates and cannabis and atrial fibrillation (AFib).
  • Compared with non-users, the researchers’ analysis shows that the substances are individually associated with an increased risk of developing AFib after adjusting for cardiovascular risk factors.
  • Cannabis use is associated with a 35% increased chance of developing AFib.
  • Methamphetamine was associated with the greatest risk with an 86% increase.

According to American Heart Association (AHA)more than 2.7 million Americans live with atrial fibrillation (AFib), a condition that causes an irregular heartbeat or arrhythmia.

AFib can lead to blood clots, stroke, heart failure, and other serious heart problems.

A new observational study investigated the long-term effects of drugs such as methamphetamine, cocaine, opiates and cannabis and found a link to an increased risk of AFib.

“The adverse effects of these drugs are placed in the context of an imminent catastrophic event that either happens or doesn’t happen, which makes sense because most of the medical literature on the subject is based largely on case reports,” study author Dr. Gregory M. Marcusprofessor of medicine at the University of California, San Francisco, said Medical news today.

dr. Marcus added that the study provides “unique evidence that the use of these substances increases the long-term risk of developing a chronic disease known to adversely affect patients in ways that are often lifelong.”

The study was recently published in Oxford Academics’ European Heart Journal.

dr. Rigved Tadwalkarboard-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, who was not involved in the study, said MNT that people can experience atrial fibrillation in different ways.

“Some people may be completely asymptomatic when they have fibrillation, others may only experience minor palpitations, which is really just the feeling of an irregular heartbeat,” said Dr. Tadwalkar.

“Others can actually have quite extreme distress when they go into AFib, just because their heart rate can be so fast that it can cause, not only a pounding heart, but shortness of breath, lightheadedness, and also chest pain.”

According to Dr. Tadwalkar, AFib cannot always be detected during an examination because symptoms do not always appear.

“You can go to the doctor’s office, get an EKG and not find atrial fibrillation because basically that EKG [just] a tape of a few seconds of what is happening,” he explained.

In addition, AFib can complicate other medical conditions.

“Someone who comes in very sick with an infection like pneumonia or a urinary tract infection – but then they have atrial fibrillation on top of that – that can really make their hospitalization much more complicated,” added Dr. Tadwalkar.

“In the long term, we are most concerned about atrial fibrillation because there is a risk of embolism and blood clots. Although these blood clots can go anywhere, what worries us the most, because of the proximity to the heart and because it is a common occurrence, is the possibility of a stroke.”

– Dr. Rigved Tadwalkar, board certified cardiologist

dr. Tadwalkar said some risk factors for AFib are beyond our control, including aging and family history.

He noted that high blood pressure and lifestyle factors such as alcohol and tobacco can also increase a person’s risk for AFib.

“Theoretically, if someone takes better care of their health, there should be a lower risk of developing atrial fibrillation,” Dr. Tadwalkar said.

For the study, researchers started with data from 23,561,884 Californians who visited an emergency department, ambulatory surgical facility or hospital from January 2005 to December 2015.

Of these individuals, 98,271 reported using methamphetamine, 48,701 cocaine, 10,032 opiates, and 132,834 cannabis.

During the study period, 42%, or 998,747 patients (4.2%) without prior AFib developed the condition.

After adjusting for established cardiovascular risk factors, the researchers found:

  • methamphetamine use increased AFib risk by 86%
  • opiate use increases AFib risk by 74%
  • cocaine use increases AFib risk by 61%
  • cannabis use increases AFib risk by 35%

Methamphetamine was associated with the greatest increase in AFib risk. According to a newsthis was the first study to look at the association between cannabis use and an increased risk of developing AFib.

“A common limitation of studies investigating the use of different substances is the reliance on self-report, which can be particularly unreliable in the context of illicit substances,” said Dr. Marcus. “The current study used health coding [from the healthcare providers] instead of that.”

dr. Tadwalkar added, “We kind of knew that, but we didn’t really have the precision that this study provides.”

dr. Marcus noted that while “cannabis may be considered healthy by many, these data suggest otherwise, providing evidence that may motivate some users to quit smoking.”

dr. Tadwalkar said the increased risk for AFib with cannabis use is a significant public health problem.

“Anytime there’s something out there that people enjoy, and then you kind of add the legal aspect, you kind of think there’s a green light,” Dr. Tadwalkar said. “But those public health issues haven’t been fully addressed, and I think that’s really the heart of the problem.”

Because it was an observational study, Dr. Marcus noted that they were unable to determine specific types or amounts of substance use. among subjects.

Although he did not establish a dose-response relationship between the drugs and AFib, Dr. Tadwalkar said the study may suggest that her cohort includes heavy users.

“The reason I say that is because the data collected from the study was from individuals who found care in more acute settings,” he said.

As for the difference in risk between smoking cannabis flower and consuming edibles, Dr. Marcus said the study was unable to distinguish between different forms of cannabis consumption.

dr. Tadwalkar explained how the different drugs used in the study work in different ways but can have similar effects.

“There are probably two common generalized mechanisms by which atrial fibrillation can be induced,” said Dr. Tadwalkar.

“One is autonomic dysfunction [where] there is a rapid change, or rather rapid change, in how compassionate and parasympathetic work of the nervous system. So these changes in the nervous system are probably largely responsible for how fibrillation is triggered or promoted.”

“The other—which is a little more specific to the heart—is a phenomenon we call ‘electrical reshaping,'” [which consists of] changes in specific activities ion channels, and as a result, protein expression. Specifically for cannabis, animal models have shown that reduction mitochondrial calcium content can do these myocyteswhich heart muscle cells are more prone to oxidative stress.”

dr. Marcus hopes that future research will answer questions that the current study did not address.

“We would be interested in determining how many of these effects might be immediate versus requiring repeated and chronic use of these substances,” he said.

“Distinguishing whether the method of cannabis consumption matters is an important next step.”

“An observational study such as this is not well equipped to reliably infer cause and effect relationships. We also hope to conduct prospective interventional studies to more clearly address unknown and unmeasured confounders that may have been operative, despite our best attempts at statistical adjustment.”

– Dr. Gregory M. Marcus, author of the study

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