Table 1.

Reviews from the past 5 years highlighting the potential impact of cannabis intake on the increase in risk of myocardial infarction and other severe cardiovascular disorders.

Type of study Number of Patients/ Sample/Evaluation Period	Results	Final Conclusion	References
Systematic review 115 articles (81 case reports, 29 observational studies, 3 clinical trials and 2 experimental studies). 116 individuals in case reports, mean age 31 (2011–2016)	-individuals (82% men) mainly suffered from ischemic strokes (27 cases) or myocardial infarctions (33 cases) -11 deaths from cardiovascular disease following exposure to cannabis-based products	association between exposure to cannabis-based products and cardiovascular disease; evidence stronger for ischemic strokes than for any other cardiovascular diseases	[54]
Epidemiologic study from NIS 2,451,933 acute MI patients, mean age 49 (2010-2014)	cannabis use raised the risk of acute MI by 3–8%	importance of patient history including recreational drug use in identifying the etiology of an unexplained MI	[55]
Epidemiologic study from NIS 316,397 patients, aged 18–55 (2009–2010)	heart failure (1.4 vs. 1.2%), cerebrovascular accidents (1.03 vs. 0.62%), CAD (5.0 vs. 4.6%) and sudden cardiac death (0.21 vs. 0.17%) significantly higher in cannabis users	cannabis use is an independent predictor of heart failure and cerebrovascular accidents	[56]
Retrospective cohort analysis 292,770 patients with a history of cannabis abuse and 10,542,348 age- and sex-matched controls, mean age 37 (2011–2016)	3-year cumulative incidence of MI significantly higher in the cannabis-abuse group than in controls (1.37% vs. 0.54%); most pronounced risk in the young and middle-aged	cannabis abuse may be associated with an elevated risk of MI independent of other cardiovascular risk factors, with higher relative risk in women and younger age groups	[53]
Epidemiologic study from NIS 52,290,927 hospitalized patients, aged 18–39 years (2007–2014)	hospitalizations among young cannabis users, compared to non-users increased by 50% for MI, 79% for arrhythmias, 300% for stroke and 75% for venous thromboembolic events	young cannabis users are more at risk in hospitalizations for acute MI, arrhythmia, and stroke	[57]
Scoping review 92 articles (1 randomized control trial, 4 systematic reviews, 19 literature reviews, 11 large database reviews, and 42 case reports/series) (2003–2018)	-51 cases of cannabis-related MI -71% of patients suffered from ST elevation MI (STEMI) -22% of patients presented with an out-of-hospital cardiac arrest or had an arrest prior to intervention; half of these patients died	-cannabis-induced MI especially prevalent among young healthy patients, presenting shortly after use -users aged 18–36 years had an increased risk for acute coronary syndrome compared to non-users	[13]
Epidemiologic study from NHANES 89.6 million adults who reported marijuana use (2005–2016)	2015–2016: 2 million (2.3%) cannabis users have a cardiovascular disease	screening for marijuana use should be conducted in young patients with cardiovascular disease	[14]
Epidemiologic study from NIS 3,307,310 hospitalizations were noted with cannabis use disorder, mean age 36 (2007–2014)	among cannabis users 0.7% (n = 24,148) had malignant hypertension	it is necessary to develop an intervention to raise awareness regarding the deleterious effect of cannabis use and to curtail additional healthcare costs	[58]
Retrospective longitudinal cohort study 18,653 adult cannabis patients were matched to 51,243 controls, aged 31–60 years (2014–2017)	incidence rates for ACS or stroke were 7.19/1000 and 5.67/1000 person/year in the cannabis and control group	medical cannabis authorization associated with increased risk of ED visits or hospitalization for cardiovascular events including stroke and ACS	[59]
Systematic review 16 studies: 4 cohort, 8 case-control studies, 1 case-crossover study, 2 randomized controlled trials and 1 descriptive study with 10 to 118,659,619 participants (1970–2018)	marijuana use was related to an increased risk of MI in 2 studies and of stroke in 6 studies (within 24 h)	marijuana users may be at increased risk of cardiovascular events	[60]
Epidemiologic study from NHANES 3634 participants (1988–1994)	about 26.0% (n = 900) of participants (mean age 48) were ever cannabis users and 15.5% (n = 538) had myocardial injury	cannabis use increased risk of myocardial injury among people without cardiovascular disease; effect increased by coexistent hypertension	[61]
Epidemiologic study from BRFSS 33,173 young adult par-ticipants, 4610 (17.5%) respondents reported recent cannabis use (2017–2018)	MI more frequent among recent cannabis users (61 of 4610, 1.3%) relative to non-users (240 of 28,563, 0.8%) history of MI associated with cannabis use of more than 4 times per month and with smoking as the primary method of consumption	-association between recent cannabis use and history of MI in young adults -increasing cannabis use in an at-risk population might have negative implications for cardiovascular health	[62]

ACS, acute coronary syndrome; BRFSS Behavioral Risk Factor Surveillance System Survey; CAD, coronary artery disease; ED, emergency department; MI, myocardial infarction; NHANES, National Health and Nutrition Examination Survey; NIS, National Inpatient Sample; STEMI, ST segment elevation myocardial infarction.