Cardiovascular Disease – Medical Marijuana Research Overview

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The term cardiovascular disease refers to a collection of diseases that affect the heart and circulatory system. Studies have shown cannabis lowers blood pressure by dilating arteries and reduce the damage caused by heart attacks and strokes.

Overview of Cardiovascular Disease

Cardiovascular disease is a term used to classify a variety of diseases related to the heart. Most types of cardiovascular disease, or heart disease as it’s also commonly referred to, are related to atherosclerosis, which is when plaque builds up along the inner walls of the arteries and restricts blood flow.

Other types of cardiovascular disease include heart failure, arrhythmia, heart valve problems and hypertension. Heart failure is when the heart isn’t pumping blood as well as it should. Arrhythmia is an abnormal rhythm of the heart. Heart valve problems are when the valves within the heart aren’t opening and closing as they should, allowing blood to flow in the wrong direction. Hypertension, or high blood pressure, is when the force of blood against artery walls is too high.

Cardiovascular disease can cause serious complications. If blood flow is severely or fully restricted to the heart, a heart attack occurs and the part of the heart that receives blood will die. If blood flow is severely or fully restricted to the brain, a stroke occurs and brain cells will die. Both events are life threatening. Blood flow restriction to the extremities, most commonly the legs, can cause peripheral artery disease and pain when walking.

Preventing or reducing atherosclerosis by exercising regularly, eating healthy, achieving a healthy body weight and the cessation of smoking, reduces the risk of heart disease.

Findings: Effects of Cannabis on Cardiovascular Disease

Cannabis has shown it limits cell damage and offers cardio and neuroprotective effects following ischemic events like heart attacks and strokes. These benefits are primarily due to the presence of a major cannabinoid found in cannabis, cannabidiol (CBD).

When administered shortly prior to a heart attack in animal trials, CBD has been found to significantly reduce infarct size (cell death), oxidative stress, inflammation, and fibrosis, and preserve the performance of the left ventricle (Durst, et al., 2007) (Rajesh, et al., 2010) (Walsh, et al., 2010). In addition, CBD has demonstrated its capability as an anti-arrhythmic and can restore regular rhythm following an ischemic attack (Walsh, et al., 2010) (Gonca & Darici, 2015).

Administering CBD shortly after a stroke has shown to protect neurons and astrocytes from damage, therefore causing an improved functional, histological, biochemical, and neurobehavior recovery (Lafuente, et al., 2011). The brain damage that occurs following strokes is associated with increases in excitotoxicity, oxidative stress and inflammation. However, administering CBD shortly after a stroke occurs has shown effective at preventing all three of these alterations (Pazos, et al., 2013) (Pazos, et al., 2012).

Another major cannabinoid found in cannabis, tetrahydrocannabinol (THC), has demonstrated the ability to offer cardioprotection. One study found that very low doses of THC administered 2 hours, 48 hours, or 3 weeks continuously prior to heart attack reduced infarct size, therefore limiting heart damage (Waldman, et al., 2013). More recently, a study examining records of hospitalized patients found that recent marijuana use reduced mortality rate and the risk of intra-aortic balloon pump (IABP) placement and shock following a heart attack (Brauser, 2016).

In both animal and human studies, cannabinoids have been found to cause blood vessels to vasodilate, improving blood flow and reducing blood pressure (Stanley & O’Sullivan, 2014a) (Stanley & O’Sullivan, 2014b) (Herradon, Martin & Lopez-Miranda, 2007). Another study found that marijuana use before a heart attack may improve survival rate while in the hospital. CBD specifically has shown to be a vasodilator, allowing for greater blood flow and reducing the damage to arterial walls and lowers the risk of heart attack and stroke (Stanley, Hind & O’Sullivan, 2013). This vasodilator effect has been shown to help normalize blood pressure (Batkai, et al., 2004).

It’s important to note that in other studies, cannabis use has been found to be associated with an increased risk of cardiovascular complications (Jouanjus, Lapeyre-Mestre & Micallef, 2014). Smoking marijuana increases heart rate and standing blood pressure and reduces lying blood pressure (Mittleman, et al., 2001). However, one study found that smoking marijuana was found to be a rare trigger of heart attacks (Mittleman, et al., 2001). Another found that cannabis, which is commonly done for its pain relieving effects, has been shown to cause less cardiovascular problems than opiates (Frishman, Del Vecchio, Sanal & Ismail, 2003).

States That Have Approved Medical Marijuana for Cardiovascular Disease

No states have approved medical marijuana specifically for the treatment of cardiovascular disease. However, in Washington DC any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment. In addition, seven states will consider allowing medical marijuana to be used for the treatment of cardiovascular disease with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).

Recent Studies on Cannabis’ Effect on Cardiovascular Disease
  • In animals, CBD reduced infarct size and reduced inflammation follow a heart attack.
    Cannabidiol, a nonpsychoactive Cannabis constituent, protects against myocardial ischemic reperfusion injury.
    (http://www.ncbi.nlm.nih.gov/pubmed/17890433)
  • CBD reduced acute and apoptotic brain damage when administered shortly after an ischemic brain event in mice.
    The neuroprotective effect of cannabidiol in an in vitro model of newborn hypoxic-ischemic brain damage in mice is mediated by CB(2) and adenosine receptors.
    (http://www.ncbi.nlm.nih.gov/pubmed/19900555)
  • Cannabinoids administered to humans shortly after a stroke reduced infarct volume and improved brain functional outcome.
    Cannabinoids in experimental stroke: a systematic review and meta-analysis.
    (http://www.ncbi.nlm.nih.gov/pubmed/25492113)

References

Bátkai, S., Pacher, P., Osei-Hyiaman, D., Radaeva, S., Liu, J., Harvey-White, J., Offertaler, L., Mackie, K., Rudd, M.A., Bukoski, R.D., and Kunos, G. (2004). Endocannabinoids Acting at Cannabinoid-1 Receptors Regulate Cardiovascular Function in Hypertension. Circulation, 110(14), 1996–2002.

Brauser, D. (2016, April 6). Marijuana Use Before Acute MI May Give Survival Edge in Hospital. Medscape. Retrieved from http://www.medscape.com/viewarticle/861528.

Durst, R., Danenberg, H., Galily, R., Mechoulam, R., Meir, K., Grad, E., Beeri, R., Pugatsch, T., Tarsish, E., and Lotan, C. (2007, December). Cannabidiol, a nonpsychoactive Cannabis constituent, protects against myocardial ischemic reperfusion injury. American Journal of Physiology: Heart and Circulatory Physiology, 293(6), H3602-7.

Fishman, W.H., Del Vecchio, A., Sanal, S., and Ismail, A. (2003). Cardiovascular manifestations of substance abuse: part 2: alcohol, amphetamines, heroin, cannabis, and caffeine. Heart Disease, 5(4), 253-271.

Gonca, E., Darici, F. (2015, January). The effect of cannabidiol on ischemia/reperfusion-induced ventricular arrhythmias: the role of the adenosine A1 receptors. Journal of Cardiovascular Pharmacology and Therapeutics, 20(1), 76-83.

Heart disease. (2014, July 29). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/heart-disease/basics/definition/con-20034056.

Herradon, E., Martin, M.I., and Lopez-Miranda, V. (2007, November). Characterization of the vasorelaxant mechanisms of the endocannabinoid anandamide in rat aorta. British Journal of Pharmacology, 152(5), 699-708.

Jouanjus, E., Lapeyre-Mestre, M., and Micallef, J. (2014, April 23). Cannabis use: signal of increasing risk of serious cardiovascular disorders. Journal of American Heart Association, 3, e000638.

Lafuente, H., Alvarez, F.J., Pazos, M.R., Alvarez, A., Rey-Santano, M.C., Mielgo, V., Murgia-Esteve, X., Hilario, E., and Martinez-Orgado, J. (2011, September). Cannabidiol reduces brain damage and improves functional recovery after acute hypoxia-ischemia in newborn pigs. Pediatric Research, 70(3), 272-7.

Marijuana Use Before Acute MI May Give Survival Edge in Hospital. (2016, April 6). Medscape. Retrieved from http://www.medscape.com/viewarticle/861528.

Pazos, M.R., Cinquina, V., Gomez, A., Layunta, R., Santos, M., Fernandez-Ruiz, J., Martinez-Orgado, J. (2012, October). Cannabidiol administration after hypoxia-ischemia to newborn rats reduces long-term brain injury and restores neurobehavioral function. Neuropharmacology, 63(5), 776-83.

Pazos, M.R., Mohammed, N., Lafuente, H., Santos, M., Martinez-Pinilla, e., Moreno, E., Valdizan, E., Romero, J., Pazos, A., Franco, R., Hillard, C.J., Alvarez, F.J., and Martinez-Orgado, J. (2013, August). Mechanisms of cannabidiol neuroprotection in hypoxic-ischemic newborn pigs: role of 5HT(1A) and CB2 receptors. Neuropharmacology, 71, 282-91.

Rajesh, M., Mukhopadhyay, P., Bátkai, S., Patel, V., Saito, K., Matsumoto, S., Kashiwaya, Y., Horvath, B., Mukhopadhyay, B., Becker, L., Hasko, G., Liaudet, L., Wink, D.A., Veves, A., Mechoulam, R., and Pacher, P. (2010). Cannabidiol attenuates cardiac dysfunction, oxidative stress, fibrosis, inflammatory and cell death signaling pathways in diabetic cardiomyopathy. Journal of the American College of Cardiology, 56(25), 2115–2125.

Stanley, C.P., and O’Sullivan, S.E. (2014, March). Cyclooxygenase metabolism mediates vasorelaxation to 2-arachidonoylglycerol (2-AG) in human mesenteric arteries. Pharmacological Research, 81, 74-82.

Stanley, C.P., and O’Sullivan S.E. (2014, March). Vascular targets for cannabinoids: animal and human studies. British Journal of Pharmacology, 171(6), 1361-78.

Stanley, C. P., Hind, W. H., & O’Sullivan, S. E. (2013). Is the cardiovascular system a therapeutic target for cannabidiol? British Journal of Clinical Pharmacology, 75(2), 313–322.

Waldman, M., Hochhauser, E., Fishbein, M., Aravot, D., Shainberg, A., and Sarne, Y. (2013, June 1). An ultra-low dose of tetrahydrocannabinol provides cardioprotection. Biochemical Pharmacology, 85(11), 1626-33.

Walsh, S. K., Hepburn, C. Y., Kane, K. A., & Wainwright, C. L. (2010). Acute administration of cannabidiol in vivo suppresses ischaemia-induced cardiac arrhythmias and reduces infarct size when given at reperfusion. British Journal of Pharmacology, 160(5), 1234–1242.

What is Cardiovascular Disease? (2015, October 19). American Heart Association. Retrieved from http://www.heart.org/HEARTORG/Caregiver/Resources/WhatisCardiovascularDisease/What-is-Cardiovascular-Disease_UCM_301852_Article.jsp.

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