Marijuana-associated stress cardiomyopathy hit younger patients with more complications

Marijuana users with stress cardiomyopathy were younger (44 vs 66 years), more often male (36% vs 8%), had fewer traditional risk factors, but had higher rates of cardiac arrest, respiratory failure, and cardiogenic shock. Age over 48 was a strong predictor of any major adverse cardiac event (OR 7.8, 95% CI 2.88-21.13).

Retrospective analysis of the 2003-2011 Nationwide Inpatient Sample database comparing 210 stress cardiomyopathy admissions temporally related to marijuana use against 33,133 non-marijuana-related stress cardiomyopathy admissions.

Stress cardiomyopathy (Takotsubo) has traditionally been associated with older postmenopausal women. The association with marijuana in younger patients with more severe complications challenges clinical expectations about who develops this condition and how it behaves.

This study suggests marijuana may trigger stress cardiomyopathy through a different mechanism than the typical emotional or physical stressor, and the resulting disease course may be more severe despite affecting younger, otherwise healthier patients.

Administrative database cannot prove causation. "Temporally related" does not mean directly caused. Small marijuana-user subgroup (210 cases). Cannabis use likely underreported in hospital records.