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Marijuana is risky for people taking common heart medications

More than 2 million Americans with heart conditions report that they have used marijuana, but many questions remain about the drug’s effects on the heart, according to a review published Monday in the Journal of the American College of Cardiology.

What is known, however, is that the drug can interact with common heart medications, including statins and blood thinners, potentially putting patients at risk, the review said.

Using marijuana while on a statin or a blood thinner can change how these drugs work in the body, said lead author Dr. Muthiah Vaduganathan, a cardiologist at the Brigham and Women’s Hospital in Boston.

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That’s because the same liver enzymes that break down statins or blood thinners also break down the compounds in marijuana, he said. Using them simultaneously with marijuana can change the effectiveness or the potency of the medications.

For example, marijuana can increase the levels of the blood thinner warfarin in the body, which can lead to excessive bleeding, according to the review. One case report published last year found that people using marijuana while on warfarin may need to reduce their dosage by as much as 30 percent. With statins, pot can boost the potency, which could lead to dangerous drops in blood pressure.

If people who are on heart-related medications do choose to use marijuana, it’s important that they tell their doctor and their pharmacist, so the medication dosages can be adjusted if needed.

“The first step is having an open discussion with clinicians, because it does influence some parts of their care,” Vaduganathan said. And certain heart health patients should avoid pot entirely.

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Based on the available evidence, the highest risk patients — such as people who recently had a heart attack or were hospitalized for a heart problem — should be counseled against using marijuana, or advised to limit its use, he said.

People not taking heart medications are also advised to pay attention to how pot affects the heartbeat.

“Always pay close attention to the way marijuana affects the heartbeat.” said Dr. Sergio Fazio, a professor of cardiovascular medicine at Oregon Health & Science University in Portland. Palpitations —when the heart races, pounds or skips a beat — are a common side effect of marijuana and could be dangerous for someone with an existing condition.

“If you sometimes feel your heart pounding or beating out of whack, these are signals that you should not ingest marijuana,” Fazio, who was not involved with the new review, said.

Dr. Carl Lavie, medical director of cardiac rehabilitation and preventive cardiology at the Ochsner Clinic in New Orleans, said that THC, the main psychoactive ingredient in cannabis, may cause platelets in the blood to clump and form clots, increasing a person’s risk for stroke or heart attack.

Smoke, vape or eat?

How users ingest marijuana also plays a role in how risky the drug may be for people with heart problems.

The latest data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, which surveys people’s health activities, found that nearly 80 percent of adult marijuana users reported smoking the drug.

“Inhalation and vaping of anything that isn’t meant to be in the lungs, even water, is a bad idea,” Fazio said.

Though marijuana affects the entire cardiovascular system regardless of how it’s ingested, Fazio said that edibles are the safest route, as smoking poses many of the same risks as inhaling tobacco. And vaping, as demonstrated by the ongoing outbreak of serious illnesses, introduces a bevy of risks.

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Still, edibles also come with risk. It’s very easy to ingest a much higher dose of marijuana when consuming it as an edible. People who opt for edibles should understand exactly how much is in each serving and should not take more if they don’t feel its effects right away.

“The problem is knowing the purity and dose, and this is extremely variable among different products regardless of the delivery system,” Lavie told NBC News in an email. “A low dose of pure THC is safer than a high dose of THC that has many bad contaminants.”

“I’m not sure people are always aware of what exactly they are getting,” he added.

Synthetic forms of marijuana, including K2, can also pose severe health problems, Lavie said. In 2018, contaminated synthetic pot in Illinois caused bleeding disorders that were so severe some doctors nearly mistook patients’ symptoms for Ebola.

Synthetic pot can also be up to 100 times as potent as the THC in the cannabis plant, making these versions even more dangerous for people taking statins or blood thinners.

It’s possible that marijuana isn’t always bad for the heart, however. Using medical marijuana as prescribed could lead to less stress, for example.

“Anytime someone says that they were able to get eight hours of peaceful sleep because they used a little bit of marijuana, their cardiovascular health will likely be better off with the use of marijuana,” Fazio said. “When you move to the purely recreational use, that’s where the risks associated with heart problems potentially outweigh the benefits.”

Marijuana can interact with people's heart medications, like statins and blood thinners, potentially putting them at risk for heart health problems.

Marijuana can be harmful for heart patients, but improves some risk factors, studies show

There’s more evidence that smoking marijuana can be dangerous for people with heart disease, according to two new studies presented recently at the American Heart Association’s Scientific Sessions. But in an unexpected twist, people who use cannabis were less likely to experience sudden kidney failure, the researchers found.

Patients who smoked marijuana and underwent angioplasty to clear blocked arteries were more likely to experience stroke and bleeding after the nonsurgical procedure than those who didn’t use pot, one study found. The second study concluded that patients who had survived a heart attack and used marijuana were more likely than those who did not use cannabis to have a subsequent heart attack. Both studies were released Monday.

“Marijuana is becoming more accessible, and patients should be aware of the increased risk after [angioplasty],” said the lead author of the study, Dr. Sang Gune Yoo, an internal medicine resident at the University of Michigan. “While these are risks to be aware of, they shouldn’t deter patients from obtaining this lifesaving procedure.”

In fact, four more states legalized recreational marijuana during the 2020 election, bringing the total to 15 plus the District of Columbia. Moreover, 34 states, plus D.C., have made medical marijuana legal.

The new findings are another example of why we need more studies into the effects of cannabis on the health of the heart and the rest of the body, Yoo said, noting that its classification by the federal government as a Schedule 1 drug has hindered scientific research.

The research is especially relevant for older Americans. Heart disease is the No. 1 killer in the U.S. and the Centers for Disease Control and Prevention estimates that each year approximately 805,000 Americans have a heart attack. The majority, or 605,000, are first-time heart attacks. Each year hundreds of thousands of patients in the U.S. have coronary angioplasty — a procedure for blocked arteries that improves blood flow to the heart, according to the American Heart Association. Many of those patients also receive stents, a small, wire mesh tube which helps keep the artery open.

To take a closer look at the impact of marijuana on angioplasty outcomes, Yoo and his colleagues examined data on 113,477 Michigan patients, 3,970 of whom self-identified as marijuana users. After matching 3,903 users with 3,903 nonusers, the researchers found that more pot smokers experienced bleeding (5.2 percent vs. 3.4 percent) and strokes (0.3 percent vs. 0.1 percent).

An intriguing finding that the authors couldn’t explain was that the marijuana users were less likely to experience sudden kidney failure.

Is it THC or the smoke?

In the other study, which analyzed information from a national database, researchers found that among patients who had an artery-clearing procedure after a heart attack, those who used marijuana had a higher rate of subsequent heart attacks than those who don’t use cannabis, or 7.2 percent vs. 4.5 percent. This study also had an intriguing finding: Heart attack risk factors — including hypertension, diabetes and high cholesterol — were significantly lower in cannabis users.

Experts contacted by NBC News had mixed reactions to the new reports.

Is marijuana bad for the heart? Marijuana is now legal in 15 states, but new research shows that smoking weed raises risk for heart patients.