Marijuana Use, Diet, Body Mass Index, and Cardiovascular Risk Factors (from the CARDIA Study)

doi:10.1016/j.amjcard.2006.03.024

The American Journal of Cardiology

Volume 98, Issue 4, 15 August 2006, Pages 478-484

https://doi.org/10.1016/j.amjcard.2006.03.024 Get rights and content

Marijuana use has been associated with increased appetite, high caloric diet, acute increase in blood pressure, and decreases in high-density lipoprotein cholesterol and triglycerides. Marijuana is the most commonly used illicit drug in the United States, but its long-term effects on body mass index (BMI) and cardiovascular risk factors are unknown. Using 15 years of longitudinal data from 3,617 black and white young adults participating in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we assessed whether marijuana use was associated with caloric intake, BMI, and cardiovascular risk factors. Of the 3,617 participants, 1,365 (38%) reported ever using marijuana. Marijuana use was associated with male gender, tobacco smoking, and other illicit drug use. More extensive marijuana use was associated with a higher caloric intake (2,746 kcal/day in never users to 3,365 kcal/day in those who used marijuana for ≥1,800 days over 15 years) and alcohol intake (3.6 to 10.8 drinks/week), systolic blood pressure (112.7 to 116.5 mm Hg), and triglyceride levels (84 to 100 mg/dl or 0.95 to 1.13 mmol/L, all p values for trend <0.001), but not with higher BMI and lipid and glucose levels. In multivariate analysis, the associations between marijuana use and systolic blood pressure and triglycerides disappeared, having been mainly confounded by greater alcohol use in marijuana users. In conclusion, although marijuana use was not independently associated with cardiovascular risk factors, it was associated with other unhealthy behaviors, such as high caloric diet, tobacco smoking, and other illicit drug use, which all have long-term detrimental effects on health.

Section snippets

Study design

The Coronary Artery Risk Development in Young Adults (CARDIA) study is a multicenter, longitudinal study of the development of coronary artery disease risk factors in young adults. The cohort enrolled 5,115 black and white adults who were 18 to 30 years of age in 1985 to 1986 and recruited from 4 metropolitan areas (Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California). With informed consent of participants and approval of the institutional review board at

Participant characteristics

Baseline characteristics are presented in Table 1. Most marijuana users (89%) reported using marijuana for <1,800 days over the specified 15 years (average 10 days/month). Only 37 participants (1%) used marijuana for ≥3,600 days (20 days/month), 14 of whom used it for ≥4,500 days (25 days/month). Higher marijuana use was associated with male gender, tobacco smoking, use of other illicit drugs, less education, and lower income. Higher marijuana use was associated with higher physical activity

Discussion

In this population-based study of young adults, marijuana use was associated with higher caloric intake but was not independently associated with BMI or cardiovascular risk factors. Although marijuana use was not independently associated with physiologic markers of increased cardiovascular risk, it was strongly associated with other unhealthy behaviors, such as high dietary energy intake, tobacco smoking, and use of other illicit drugs, which have long-term detrimental effects on health.

Our

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Cited by (158)

A Review of the Effects of Adolescent Cannabis Use on Physical Health
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Associations Between Monthly Cannabis Use and Myocardial Infarction in Middle-Aged Adults: NHANES 2009 to 2018, Corroon et al
2023, American Journal of Cardiology
Mechanistic research suggests using Cannabis sativa L. (cannabis or marijuana) may increase the risk of cardiometabolic disease, but observational studies investigating associations between cannabis use and myocardial infarction (MI) have reported inconsistent results. Cross-sectional National Health and Nutrition Examination Survey data from five 2-year cycles between 2009 and 2018 and representing 9,769 middle-aged adults (35 to 59 years old) were analyzed. Multivariable logistic regression models accounting for sampling weights and adjusting for cardiovascular risk factors were used to assess associations between a history of monthly cannabis use before MI and a subsequent MI. A quarter of respondents (n = 2,220) reported a history of monthly use >1 year before an MI. A history of MI was reported by 2.1% of all respondents and 3.2.% of those who reported a history of monthly use. In fully adjusted multivariable models, and compared with never use, a history of monthly cannabis use preceding an MI was not associated with an MI (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.35 to 1.71). However, when stratified by recent use, the odds of MI were threefold greater (OR 2.98, 95% CI 1.08 to 8.60) when no use was reported within the past month than when use was reported within the past month. Duration of monthly use was also not significantly associated with MI, including monthly use >10 years (OR 0.78, 95% CI 0.30 to 2.01). In conclusion, in a representative sample of middle-aged US adults, a history of monthly cannabis use >1 year before an MI was not associated with a subsequent physician-diagnosed MI, except for threefold greater odds when cannabis was not used within the past month.
Nonneurological aspects of the endocannabinoid system: Nonalcoholic fatty liver disease
2023, Neurobiology and Physiology of the Endocannabinoid System
Nonalcoholic fatty liver disease (NAFLD) is a global leading cause of the increased incidence of liver mortality and morbidity. It has been reported that the implication of the endocannabinoid system in the pathogenesis of NAFLD may be due to the activation of the cannabinoid receptors CB1 and CB2 via the increased fat influx to the liver. This inhibits fatty acid oxidation and leads to the activation of some transcriptional factors, including sterol regulatory element binding protein (SREBP-1c) and stearoyl-CoA desaturase (SCD1), involved in lipogenesis. The overexpression of CB1 may be due to lipid metabolism dysregulation, while a high CB2 expression is possibly due to the increases levels of some proinflammatory cytokines during nonalcoholic steatohepatitis (NASH). Cannabis use in treating some diseases, including NAFLD, is attracting considerable interest due to the positive impact on CB1 receptors. This chapter sheds light on the implication of the endocannabinoid system in the pathogenesis of NAFLD and whether the use of cannabis is effective in treating NAFLD.
Reduced BMI in Cannabis users: Regulation, mechanisms, and public health impact
2023, Medicinal Usage of Cannabis and Cannabinoids
The endocannabinoid system plays a central role in energy homeostasis. An elevated ratio of dietary omega-6/omega-3 fatty acids, characteristic of processed foods, increases endocannabinoid tone by increasing levels of the signaling molecules AEA and 2-AG. Increased levels of these signals promote weight gain by increasing the uptake and storage of energy and reduce the metabolic rate. Cannabis contains cannabinoids that mimic the actions of AEA and 2-AG, stimulating appetite during acute exposures. Paradoxically, Cannabis use is associated with a 38% decrease in the risk of obesity and is therefore likely to decrease the risk of associated diseases including major causes of premature death and disability. This appears to occur when rapid downregulation of the CB1 receptor in response to the surge of THC during acute Cannabis exposures results in a prolonged decrease in sensitivity of the endocannabinoid system, counteracting the stimulation of the endocannabinoid system by diet.
A Review of the Effects of Adolescent Cannabis Use on Physical Health
2023, Child and Adolescent Psychiatric Clinics of North America
Citation Excerpt :
Rimonabant was an effective weight loss drug; however, it was denied approval by the Food and Drug Administration because of severe psychiatric side effects.147 In summary, cannabis use is associated with a lower BMI,57,58,125,133–136 poorer diet such as eating fewer vegetables and fruits,140–143 and higher levels of exercise engagement.144,145 However, more research is needed among adolescents to understand if these associations are present earlier in life and the mechanisms through which cannabis use acts on these factors.
Acute coronary syndrome and cannabis use: a retrospective cohort study
2022, Annales de Cardiologie et d'Angeiologie
Le syndrome coronarien aigu (SCA) est le mode d'entrée clinique habituel dans la maladie coronarienne. La France est le pays européen dont la prévalence de consommation de cannabis est la plus élevée, avec une augmentation des complications cardiovasculaires graves dont l'infarctus, liées à cette drogue. L'objectif principal de cette étude était de comparer le profil clinique et cardiologique des patients présentant un SCA selon l'exposition à une consommation de cannabis.
Nous avons réalisé une étude de cohorte, rétrospective, monocentrique, de type exposés/non-exposé chez tous les patients adultes ( > 18 ans) admis pour un SCA en USIC entre le 1^er janvier 2012 et le 31 décembre 2021 au Centre Hospitalier de Troyes, avec la mention d'une consommation de cannabis dans le dossier médical. Un appariement a été réalisé, pour que chaque patient identifié dans le groupe exposé soit associé à un patient non exposé comparable pour l’âge, le sexe, la période d'hospitalisation et la typologie d’évènement cardio-vasculaire (type de SCA et topographie pour les ST+).
2745 patients admis en USIC et salle de coronarographie ont présenté un SCA ST+ ou ST − du 01/01/2012 au 31/12/2021 au CHT. Pour 31 d'entre eux (1,1 %), nous avons relevé une consommation de cannabis, laquelle concerne 7,9 % des SCA ST+ âgés de moins de 50 ans.
Le lien entre consommation de cannabis et SCA est établi mais les études concernant la place du cannabis dans la filière SCA sont peu nombreuses en France. Nos résultats montrent ici l'intérêt du dépistage de ces patients en USIC et du développement d'une filière axée sur leurs besoins et la spécificité de leur prise en charge au décours du SCA.
Acute coronary syndrome (ACS) is the usual clinical entry point for coronary heart disease. France is the European country with the highest prevalence of cannabis use and an increase in serious cardiovascular complications, including infarction, related to cannabis. The main objective was to compare the clinical and cardiological profile of patients with ACS according to exposure to cannabis use.
We conducted a retrospective, single-centre, exposure-non-exposure cohort study of all adult patients (> 18 years) admitted for ACS in the ICU between January 1, 2012 and December 31, 2021 at the Centre Hospitalier de Troyes, with mention of cannabis use in the medical record. A matching was performed so that each patient identified in the exposed group was associated with a comparable unexposed patient on age, sex, period of hospitalisation and cardiovascular event typology (type of ACS and topography for ST+).
2745 patients admitted to the ICU and the coronary angiography room presented an ST+ or ST− ACS from 01/01/2012 to 31/12/2021 at the CHT. For 31 patients of them (1.1%), we noted cannabis consumption, which concern 7,9% of SCA ST+ aged under 50.
The link between cannabis use and ACS is established, but studies concerning the place of cannabis in the ACS pathway of an ICU are few in France. Our results show the interest of developing a specific pathway focused on the needs of patients and their specificities in post ACS management.

View all citing articles on Scopus

: This study was supported by Contracts NO1-HC-48047 through 48050 and NO1-HC-95095 from the National Heart, Lung, and Blood Institute, National Institute of Health, Bethesda, Maryland. Dr. Rodondi was supported by Grant PBLAB-102353 from the Swiss National Foundation, Berne, Switzerland.

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Preventive cardiologyMarijuana Use, Diet, Body Mass Index, and Cardiovascular Risk Factors (from the CARDIA Study)

Section snippets

Study design

Participant characteristics

Discussion

Pharmacol Biochem Behav

J Clin Epidemiol

J Am Diet Assoc

J Chronic Dis

Prev Med

Atherosclerosis

Prevalence of marijuana use disorders in the United States1991–1992 and 2001–2002

JAMA

Marijuana use. Biologic and behavioral aspects

Postgrad Med

Effects of smoked marijuana on food intake and body weight of humans living in a residential laboratory

Appetite

Dietary intake and nutritional status of US adult marijuana usersresults from the Third National Health and Nutrition Examination Survey

Public Health Nutr

Triggering myocardial infarction by marijuana

Circulation

Respiratory and immunologic consequences of marijuana smoking

J Clin Pharmacol

Cardiovascular consequences of marijuana use

J Clin Pharmacol

Some cardiovascular effects of marijuana smoking in normal volunteers

Clin Pharmacol Ther

Preventive cardiology
Marijuana Use, Diet, Body Mass Index, and Cardiovascular Risk Factors (from the CARDIA Study)