Considering Cannabis & the Cardiovascular System: A Look at Patient Outcomes

Dr. Brown:
Welcome to Heart Matters on ReachMD. I’m Dr. Alan Brown, and on this program, we're going to hear from Dr. Dustin Sulak, an integrative medicine physician with a special focus on osteopathy, mind-body medicine, and medical cannabis. Here’s Dr. Sulak now talking about the relationship between cannabis and cardiovascular outcomes.

Dr. Sulak:
Well, there is some observational data that associates either reporting cannabis use or having a positive THC urine drug screen at the time of admission with better outcomes in myocardial infarction, for example. There's been a few studies that have shown that the cannabis users seem to do better than the cannabis non-users. And there's preclinical data that provides a mechanism of action. Of course, that observational data might not be causal, and there's many potential confounders, but in animal models, cannabis and the components in cannabis even at very low doses can provide cardio protection, limiting the size of the infarct, limiting the infiltration of white blood cells, limiting inflammatory markers, and speeding recovery. And that's in a model of MI. There's also some direct cardiovascular effects that taking cannabis can cause. And these are going to be most pronounced when people inhale cannabis. So there's effects on the autonomic system. It's typically biphasic, typically a reduction in blood pressure, and that's through direct relaxation of the smooth muscles, as well as an endothelial target that ends up producing more nitric oxide. When you get this decrease in blood pressure, sometimes you get the increase in heart rate. And for people that have really fragile cardiovascular systems and can't tolerate an increase in cardiovascular demand, they absolutely should not be inhaling cannabis and they should also not be overdosing on oral cannabis. But appropriately dosed oral cannabis is very unlikely to cause cardiovascular effects of any sort.

I tell patients that when dosed appropriately, if they're under the supervision of somebody who has experience practicing with cannabis or somebody that has good resources for education on this, then I would say it's very safe for them to use it. And typically, this is not being used directly to benefit the cardiovascular disease, but all the comorbidities, and of course, sleep being a major comorbidity that can contribute to worsening cardiovascular disease. Chronic pain, getting people to be able to move more and exercise more because their pain’s under better control. It can be kind of a tonic for one's lifestyle when used appropriately to mitigate all these other things that may be contributing to cardiovascular disease, and it's also a great substitute for other substances that may be harmful, including tobacco and alcohol.

Dr. Brown:
That was Dr. Dustin Sulak talking about cannabis and cardiovascular outcomes. For ReachMD, I’m Dr. Alan Brown. To find other episodes in this series, visit ReachMD.com/HeartMatters, where you can Be Part of the Knowledge. Thanks very much for listening!