American Heart Month
A Heart to Heart about Medical Marijuana and Cardiovascular Disease :
February is American Heart Month. According to the CDC, heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. About 655,000 Americans die from heart disease each year—that's one in every four deaths.
High blood pressure, high blood cholesterol, and smoking are key risk factors for heart disease.
Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including:
Diabetes
Overweight and obesity
Unhealthy diet
Physical inactivity
Excessive alcohol use
There is a lot you can do to prevent heart disease especially by practicing self-care. Researchers define self-care as what is done to stay healthy. It is also what you do to address health problems, such as high blood pressure, diabetes, or mental health problems. It's healthy living.
Try to get a daily dose of physical activity and cook heart-healthy meals. Remember to take your medications as prescribed, keep your medical appointments, manage stress, and maintain or reach a healthy weight.
It is also important to know your heart health numbers; these are like the gauges on your car dash that tell you your oil is low. Be sure to check your blood pressure and know your blood glucose and cholesterol levels to check if you need a tune-up.
You can find more information on Heart Health and join #OurHearts are healthier together.
@ https://www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-month.
MMJ and Heart Health
Because it's American Heart Month, let's look at the effects of MMJ on heart health and what we know.
The effect of medical marijuana in preclinical studies appears to be dose-dependent. MMJ can cause your heart rate and blood pressure to temporarily increase, followed by a decrease in blood pressure, also known as orthostatic hypotension. The increase in heart rate decreases the amount of oxygen available for the heart, potentially leading to heart problems, especially for people with pre-existing unstable heart conditions.
There are many conflicting studies on MMJ and heart health. Most experts usually don't review retrospective studies. The studies typically don't show cause or effect, usually point to trends, and some are case studies with few subjects. The heart of the matter lies in the DEA's schedule for marijuana as a C1 substance without medical benefits. Consequently, the data is limited, and we don't have solid scientific studies showing the effects of MMJ on heart health. Most studies point out the risks of smoking marijuana on heart health and don't review the other formulations available like tinctures.
All drugs have risks and benefits. It's important to proceed with caution without consistent evidence. Patients with unstable cardiac disease should talk to their doctor about whether MMJ is safe to treat symptoms of your qualifying condition.
Heart Health and the Endocannabinoid System
Multiple studies have shown that the endocannabinoid system plays a role in heart health. In healthy individuals, the ECS is not highly active. It works on demand in response to injury and stress. The ECS activation in the case of heart health may be a protective response.
The ECS plays a role in maintaining blood pressure, causing the blood vessels to relax and widen, known as vasodilation. The heart's vessels dilate during vasodilation, and blood pressure decreases, causing the heart to beat faster. The fast heartbeat is called tachycardia. The decrease in blood pressure (hypotension) may cause some dizziness.
Endocannabinoids are overproduced during cell and tissue injury. Anandamide, one of the cannabinoids we make in our bodies, regulates blood pressure and heart function. The over-expression of the CB1 receptor contributes to low blood pressure and decreased heart function. While stimulating immune cells in the blood vessels, it activates CB2 receptors and maybe heart healthy. This activation may reduce inflammation and help prevent atherosclerosis, heart attack, and stroke. People with obesity, high cholesterol, or diabetes are at increased risk of cardiovascular disease.
The ECS is overactive in people with metabolic imbalances. The endocannabinoids anandamide and 2 AG are overactive, causing the stimulation of CB1 receptors by decreasing the ECS enzyme FAAH. Test drugs that are FAAH inhibitors have been shown to reduce blood pressure and heart contractility by lowering the circulating endocannabinoids. Most studies show that antagonists or adversaries of CB1 and CB2 receptors protect the heart with anti-inflammatory and antioxidative properties.
Heart Health and The Phyto Cannabinoids ~
Tetrahydrocannabinol (THC)
THC acts like the body's natural endocannabinoid anandamide. In low doses, it may increase the number of CB1 receptors and increase receptor binding. It can increase heart rate by 20-50 beats per minute. The increase in heart rate is due to a decrease in blood pressure. Most of us will become tolerant of this effect of MMJ.
Studies have also shown that THC modulates immune function in low doses, leading to decreased plaque development and inflammation in atherosclerosis. THC has been shown to inhibit an enzyme that forms a lipoprotein that can cause the hardening of the arteries.
Cannabidiol – (CBD)
CBD doesn't seem to bind to the CB1 or CB2 receptors and has been shown to have antioxidant and anti-inflammatory properties. CBD may be cardio-protective, lower blood pressure and heart rate, and improve vasodilation. It's also been shown to lower cholesterol and blood sugar. CBD doesn't seem to affect resting blood pressure or heart rate. It's been shown to reduce stress-induced blood pressure and heart rate.
Cannabinol (CBN)
CBN is a byproduct of THC, which may have anti-inflammatory, antioxidative, and pain-relieving properties. Animal studies have detected CBN in the heart tissue, lowering blood pressure without affecting heart rate.
Cannabichromene (CBC)
CBC is a minor cannabinoid and may have anti-inflammatory, anti-fungal, and
anti-bacterial properties. CBC seems to work at the CB2 receptor and may reduce blood pressure and heart rate.
Tetrahydrocannabivarin (THCV)
THCV works by blocking the CB1 receptor, like a CB1 antagonist. It may protect the heart, be suitable for inflammation and help with oxidative stress. THCV is being investigated to reduce food intake in obesity and diabetes.
Beta-Caryophyllene – is a terpene found in the cannabis plant. Beta-Caryophyllene is one of the known terpenes that activate the CB2 receptor. It has been shown to potentially reduce total
cholesterol, reduce inflammation and offer antioxidant benefits in heart health.
Suggestions to minimize risk -
Avoid smoking to improve heart health. Smoking MMJ is not permissible in Pennsylvania and smoking any organic substance may adversely affect the body.
It is important to micro-dose - start with a low dose and go slow.
Remember, oral products take longer to start working - practice patience while waiting for the effect.
If you currently take blood pressure medications, separate the dose of MMJ and your prescription drugs by two hours to minimize additive effects.
If you take warfarin, cannabinoids can alter the concentration of warfarin and increase the risk of bleeding and bruising. It is important to let your providers know if you start MMJ therapy, so they can monitor your PT INR.
If you are an older adult or have a higher fall risk, remember to stand up slowly with a chair behind you or use an assistive device to steady your gate – in case you experience any dizziness when starting or utilizing MMJ. (https://www.ncoa.org/article/6-falls-prevention-steps-to-help-your-older-loved-ones)
Talk to your recommending physicians about whether MMJ therapy is safe to treat symptoms of your qualifying condition if you have unstable heart disease.
Feel free to reach out to our Pharmacy team with any questions.
Should you feel symptoms of a heart attack - call 911 - these may include -
Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that lasts more than a few minutes or goes away and comes back.
Feeling weak, light-headed, or faint. You may also break out into a cold sweat.
Pain or discomfort in the jaw, neck, or back.
Pain or discomfort in one or both arms or shoulders.
Shortness of breath. This often comes with chest discomfort, but the shortness of breath can also happen before chest discomfort.
Other heart attack symptoms could include unusual or unexplained tiredness, nausea, or vomiting. (Source: CDC)
References:
Naturally Occurring Cannabinoids and their Role in Modulation of Cardiovascular Health Elnaz
Karimian Azari, Ph.D., Aileen Kerrigan &Annalouise O'Connor, Ph.D. Pages 625-650 | Published online: Jul 17, 2020
Pacher P, Bátkai S, Kunos G. Blood pressure regulation by endocannabinoids and receptors. Neuropharmacology. 2005 Jun;48(8):1130-8. DOI: 10.1016/j.neuropharm.2004.12.005. Epub 2005 Feb 19. PMID: 15910888; PMCID: PMC2225528.
Mittleman MA, Lewis RA,
Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation 2001 06/12;103(1524-4539; 23):2805-9.
Alshaarawy O, Elbaz HA. Cannabis use and blood pressure levels: United States National Health and Nutrition Examination Survey, 2005-2012. J Hypertens. 2016 Aug;34(8):1507-12. DOI: 10.1097/HJH.0000000000000990. PMID: 27270185; PMCID: PMC5237375.
Allen LA, Kloner RA, Carriker CR, Martel C, Morris AA, Piano MR, Rana JS, Saucedo JF; on behalf of the American Heart Association Clinical Pharmacology Committee and Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Basic Cardiovascular Sciences; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research. Medical marijuana, recreational cannabis, and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2020;142:e131–e152. DOI: 10.1161/ CIR.000000000883
Disclaimer: This information is intended for educational purposes only. It would be best not to rely on this information to substitute for or replace professional medical advice, diagnosis, or treatment. Suppose you have any concerns or questions about your health. In that case, you should always consult with a physician or other healthcare professional. The FDA has not evaluated this information, nor is it intended to diagnose, cure, or prevent any disease or disorder of any kind.