Marijuana-associated stress cardiomyopathy hit younger patients with more complications | Research

The takeaway

Among 33,343 US admissions for stress cardiomyopathy, 210 were temporally related to marijuana use. These patients were significantly younger and had more cardiac arrest, respiratory failure, and cardiogenic shock despite having fewer traditional risk factors.

Cardiologists, emergency physicians, and cannabis users concerned about cardiovascular risks.

Marijuana SC patients: younger (44 vs 66 years) but more cardiac arrest and shock

What the researchers found

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).

Why it matters

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.

The numbers in context

33,343 SC admissions; 210 (0.06%) marijuana-related; mean age 44 vs 66; 36% vs 8% male; cardiac arrest, respiratory failure, cardiogenic shock all higher; age >48 OR 7.8 for major adverse events

How the study worked

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.

What this study cannot tell us

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.

How to read the evidence

Large national database but very small marijuana subgroup. Administrative coding cannot establish causation.

When this study was published

Published in 2021 using data from 2003-2011.

The bigger picture

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.

Questions still open

What is the mechanism by which marijuana triggers stress cardiomyopathy? Is it the sympathetic activation, direct cardiac effects, or both? Would screening for marijuana use in young SC patients change management? Do these patients have a different long-term prognosis?

Common questions

What is stress cardiomyopathy?

Also called Takotsubo or broken heart syndrome, it is a temporary weakening of the heart muscle triggered by emotional or physical stress. It typically affects older women but in this study occurred in younger marijuana users with more complications.

Did marijuana users have worse outcomes?

Yes, despite being younger and having fewer traditional risk factors. They had higher rates of cardiac arrest, respiratory failure, and cardiogenic shock compared to non-marijuana-related cases.

Read the original research

Marijuana Use and Stress Cardiomyopathy in the Young.

Cureus, 13(10), e18575

View on PubMed ↗Publisher’s paper ↗

Citation

Modi, Vivek; Singh, Amitoj; Shirani, Jamshid. (2021). Marijuana Use and Stress Cardiomyopathy in the Young.. Cureus, 13(10), e18575. https://doi.org/10.7759/cureus.18575