Eight Marijuana Users Had Heart Attacks at an Average Age of 40, and Half Had Few or No Other Risk Factors | Research

The takeaway

A case series of 8 patients with 10 ST-elevation heart attacks associated with marijuana use found most were young minority males, and half had minimal or no cardiovascular risk factors beyond cannabis.

Cannabis users concerned about heart health, especially those with other risk factors.

30% of marijuana-associated heart attack patients had zero known cardiovascular risk factors

What the researchers found

Over four years at an inner-city hospital, researchers identified 8 patients (10 total events) who had ST-elevation myocardial infarction (STEMI) associated with marijuana use. The mean age was 40.1 years, ranging from 26 to 59.

The demographic profile was striking: 9 of 10 cases were male, and 8 were Black, reflecting the patient population of the urban hospital. Most concerning, 3 of 10 cases (30%) had no known cardiovascular risk factors at all on admission, and 2 had only a single risk factor. This means half of the marijuana-associated heart attacks occurred in people who would not typically be considered at risk.

All patients had angiographic evidence of obstructive coronary artery disease, and peak troponin levels were high (mean 93.5 ng/ml), indicating substantial cardiac damage.

Why it matters

Heart attacks in young people with few risk factors demand explanation. This case series adds to growing evidence that marijuana use may be an independent cardiovascular risk factor, particularly concerning given that many users and clinicians do not consider cardiac risk when assessing cannabis use.

The numbers in context

8 patients, 10 STEMI events. Mean age: 40.1 years (range 26-59). 9 male, 1 female. 30% had zero CVD risk factors. Peak troponin: mean 93.5 ng/ml. All had obstructive coronary disease on angiography.

How the study worked

Retrospective chart review of patients presenting with STEMI and positive cannabis use at a single inner-city hospital coronary care unit from December 2013 to April 2017.

What this study cannot tell us

Case series without a control group cannot establish causation. The temporal relationship between marijuana use and STEMI was not precisely characterized. Single inner-city hospital with a specific patient demographic. Selection bias: patients at this hospital may not represent all marijuana-associated cardiac events. Cannabis was self-reported and not necessarily verified by blood testing.

How to read the evidence

Preliminary evidence from a small, single-center case series without controls.

When this study was published

Published in 2017. Cannabis-cardiovascular research has expanded since.

The bigger picture

As marijuana use increases with legalization, understanding its cardiovascular profile becomes more important. While this case series cannot prove causation, the pattern of heart attacks in young patients with few traditional risk factors is consistent with marijuana acting as a trigger or contributor to acute coronary events.

Questions still open

What mechanism links marijuana to acute coronary events? Is it vasospasm, increased oxygen demand, platelet activation, or something else? Does the method of consumption (smoking vs. edibles) affect cardiac risk? Should cardiac screening be recommended for heavy marijuana users?

Common questions

Can marijuana cause a heart attack?

This case series found heart attacks associated with marijuana use in relatively young patients, many with few other risk factors. However, a case series cannot prove causation. The evidence suggests marijuana may be a contributing factor or trigger, but more rigorous studies are needed to establish a definitive causal link.

Who is most at risk for marijuana-related cardiac events?

Based on this small series, the patients were predominantly young males. However, the study cannot identify specific risk factors that make some marijuana users vulnerable to cardiac events while others are not. Traditional cardiovascular risk factors were absent or minimal in half the cases, which is concerning.

Read the original research

Clinical Characteristics and Angiographic Findings of Acute Myocardial Infarction Associated With Marijuana Use: Consecutive Case Series.

SciFed journal of cardiology, 2(1)

View on PubMed ↗

Citation

Sharma, Navneet; Lee, Justin; Aponte, Carla Saladini; Marmur, Jonathan D; Lawson, William E; Mann, Noelle N; Salifu, Moro O; Youssef, Irini; McFarlane, Samy I. (2017). Clinical Characteristics and Angiographic Findings of Acute Myocardial Infarction Associated With Marijuana Use: Consecutive Case Series.. SciFed journal of cardiology, 2(1).