Divya Ravi, MD, MPH; Mehrnaz Ghasemiesfe, MD; Deborah Korenstein, MD; Thomas Cascino, MD; Salomeh Keyhani, MD, MPH
The abstract of this study was presented orally at the 2017 Society of General Internal Medicine Annual Meeting, Washington, DC, 19 April to 22 April 2017.
Grant Support: By the National Heart, Lung, and Blood Institute (grant 1R01HL130484-01A1). Dr. Korenstein's contribution to this project was supported in part by a Cancer Center Support Grant (P30 CA008748) to Memorial Sloan Kettering Cancer Center.
Disclosures: Dr. Korenstein reports grants from the NIH/National Cancer Institute during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1548.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available at www.crd.york.ac.uk/prospero/display_record.php?RecordID=51297. Statistical code: Not applicable. Data set: Available from Dr. Ravi (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Divya Ravi, MD, MPH, The Wright Center for Graduate Medical Education, 111 North Washington Avenue, Scranton, PA 18503; e-mail, email@example.com.
Current Author Addresses: Dr. Ravi: The Wright Center for Graduate Medical Education, 111 North Washington Avenue, Scranton, PA 18503.
Drs. Ghasemiesfe and Keyhani: San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121.
Dr. Korenstein: Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017.
Dr. Cascino: Division of Cardiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109.
Author Contributions: Conception and design: D. Ravi, M. Ghasemiesfe, S. Keyhani.
Analysis and interpretation of the data: D. Ravi, M. Ghasemiesfe, D. Korenstein, T. Cascino, S. Keyhani.
Drafting of the article: D. Ravi, M. Ghasemiesfe, T. Cascino, S. Keyhani.
Critical revision for important intellectual content: M. Ghasemiesfe, D. Korenstein, T. Cascino, S. Keyhani.
Final approval of the article: D. Ravi, M. Ghasemiesfe, D. Korenstein, T. Cascino, S. Keyhani.
Provision of study materials or patients: S. Keyhani.
Statistical expertise: M. Ghasemiesfe.
Obtaining of funding: S. Keyhani.
Administrative, technical, or logistic support: D. Ravi, M. Ghasemiesfe, S. Keyhani.
Collection and assembly of data: D. Ravi, M. Ghasemiesfe, D. Korenstein, T. Cascino, S. Keyhani.
Marijuana use is increasing in the United States, and its effect on cardiovascular health is unknown.
To review harms and benefits of marijuana use in relation to cardiovascular risk factors and clinical outcomes.
PubMed, MEDLINE, EMBASE, PsycINFO, and the Cochrane Library between 1 January 1975 and 30 September 2017.
Observational studies that were published in English, enrolled adults using any form of marijuana, and reported on vascular risk factors (hyperglycemia, diabetes, dyslipidemia, and obesity) or on outcomes (stroke, myocardial infarction, cardiovascular mortality, and all-cause mortality in cardiovascular cohorts).
Study characteristics and quality were assessed by 4 reviewers independently; strength of evidence for each outcome was graded by consensus.
13 and 11 studies examined associations between marijuana use and cardiovascular risk factors and clinical outcomes, respectively. Although 6 studies suggested a metabolic benefit from marijuana use, they were based on cross-sectional designs and were not supported by prospective studies. Evidence examining the effect of marijuana on diabetes, dyslipidemia, acute myocardial infarction, stroke, or cardiovascular and all-cause mortality was insufficient. Although the current literature includes several long-term prospective studies, they are limited by recall bias, inadequate exposure assessment, minimal marijuana exposure, and a predominance of low-risk cohorts.
Poor- or moderate-quality data, inadequate assessment of marijuana exposure and minimal exposure in the populations studied, and variation in study design.
Evidence examining the effect of marijuana on cardiovascular risk factors and outcomes, including stroke and myocardial infarction, is insufficient.
National Heart, Lung, and Blood Institute. (PROSPERO: CRD42016051297)
Evidence search and selection.
Appendix Table 1. Studies That Examined Exposure to MJ and CVD
Appendix Table 2. Studies That Examined Exposure to MJ and CVD
Table. Strength of Evidence Between Marijuana and Each Risk Factor and Outcome
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Ravi D, Ghasemiesfe M, Korenstein D, Cascino T, Keyhani S. Associations Between Marijuana Use and Cardiovascular Risk Factors and Outcomes: A Systematic Review. Ann Intern Med. ;168:187–194. doi: 10.7326/M17-1548
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Published: Ann Intern Med. 2018;168(3):187-194.
Published at www.annals.org on 23 January 2018
Cardiology, Coronary Risk Factors, Prevention/Screening, Tobacco, Alcohol, and Other Substance Abuse.
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