Cannabis use among adults with congenital heart disease was common globally, with co-use having the most negative effects | Research

The takeaway

Among 4,028 adults with congenital heart disease across 15 countries, cannabis use was common (8% of men, 4% of women) and co-use with tobacco had the most negative impact on mental health.

Cardiologists managing adult CHD, patients with congenital heart disease, and public health researchers.

Co-use most harmful to mental health

What the researchers found

Cannabis-only use had a negligible effect on physical functioning, mental health, and quality of life. Tobacco-only had a small negative effect. Co-use of both had the most detrimental effects, particularly a moderate negative impact on mental health. Large intercountry variation was observed.

Why it matters

Adults with congenital heart disease are a uniquely vulnerable population for substance use effects. Knowing that cannabis alone has negligible cardiovascular impact but co-use with tobacco is harmful can inform clinical counseling.

The numbers in context

4,028 adults with CHD from 15 countries; men: 14% tobacco, 8% cannabis, 4% both; women: 11% tobacco, 4% cannabis, 1% both. Switzerland highest smoking (24% men); Canada highest cannabis (19% men).

How the study worked

Cross-sectional APPROACH-IS study of 4,028 adults with CHD from 15 countries, using validated questionnaires with propensity-weighted doubly robust estimation to balance groups.

What this study cannot tell us

Cross-sectional design. Self-reported substance use. Cannot assess acute cardiovascular events. Propensity weighting cannot fully eliminate confounding. Variable legal status of cannabis across 15 countries affects reporting.

How to read the evidence

Moderate: large international sample with sophisticated statistical methods, but cross-sectional and self-reported.

When this study was published

Published in 2019.

The bigger picture

The finding that cannabis alone had negligible impact on patient-reported outcomes in a cardiovascularly vulnerable population is noteworthy, though it does not address acute cardiovascular events, which are typically captured through ER data rather than surveys.

Questions still open

Does the negligible effect of cannabis-only use in CHD patients hold up when examining acute cardiovascular events? Would cannabis cessation improve mental health outcomes for co-users?

Common questions

Is cannabis safe for people with heart conditions?

In this survey of 4,028 adults with congenital heart disease, cannabis-only use had negligible effects on self-reported functioning, but this does not address acute cardiovascular events.

Is combining cannabis and tobacco worse?

Yes, co-use of cannabis and tobacco had the most detrimental effects, particularly on mental health, compared to using either substance alone.

Read the original research

Prevalence and Effects of Cigarette Smoking, Cannabis Consumption, and Co-use in Adults From 15 Countries With Congenital Heart Disease.

The Canadian journal of cardiology, 35(12), 1842-1850

View on PubMed ↗Publisher’s paper ↗

Citation

Moons, Philip; Luyckx, Koen; Kovacs, Adrienne H; Holbein, Christina E; Thomet, Corina; Budts, Werner; Enomoto, Junko; Sluman, Maayke A; Yang, Hsiao-Ling; Jackson, Jamie L; Khairy, Paul; Cook, Stephen C; Chidambarathanu, Shanthi; Alday, Luis; Eriksen, Katrine; Dellborg, Mikael; Berghammer, Malin; Johansson, Bengt; Mackie, Andrew S; Menahem, Samuel; Caruana, Maryanne; Veldtman, Gruschen; Soufi, Alexandra; Fernandes, Susan M; White, Kamila; Callus, Edward; Kutty, Shelby; Apers, Silke. (2019). Prevalence and Effects of Cigarette Smoking, Cannabis Consumption, and Co-use in Adults From 15 Countries With Congenital Heart Disease.. The Canadian journal of cardiology, 35(12), 1842-1850. https://doi.org/10.1016/j.cjca.2019.07.635