Cannabis Use and Cardiovascular Risks

Introduction to Cannabis-Induced Cardiovascular Effects

The American College of Physicians suggests that cannabis use can cause priapism, a rare but documented potential side effect, in some individuals, particularly with higher THC concentrations and certain methods of consumption 1
The American Society of Clinical Oncology notes that most clinical guidelines on cannabis do not specifically mention priapism as a known side effect, with evidence consisting primarily of case reports rather than large-scale studies 2
Cannabis use is associated with increased stroke risk in a dose-dependent manner, with more frequent than once-weekly cannabis use associated with elevated stroke/TIA risk, according to the Stroke journal 3

Higher THC concentrations, such as those found in modern cannabis products, may increase the risk of adverse effects, including rare cardiovascular complications like priapism, according to the American College of Physicians 1
The method of consumption, such as smoking, vaping, or edibles, may affect risk profiles for cannabis-induced priapism, as suggested by the American College of Physicians 1
THC inhalation can cause orthostatic hypotension, particularly with heavy acute and chronic use, and is associated with a greater incidence of myocardial ischemia in at-risk individuals, as reported by the British Journal of Anaesthesia 4
Cannabis use is linked to an increase in heart rate (tachycardia), blood pressure, and an increased risk of adverse cardiovascular events such as myocardial infarction and stroke, as noted by the American College of Physicians 1

Patients presenting with priapism and reporting cannabis use should be treated as a urological emergency according to standard protocols, with consideration of aspiration of blood from the corpora cavernosa and intra-cavernous injection of vasoconstrictors as first-line treatment, although cannabis-induced priapism may be resistant to standard treatments in some cases 1
The American Heart Association recommends positioning the patient supine with legs elevated and performing physical counterpressure maneuvers (PCMs) if presyncope symptoms occur 5, 6

Patients using cannabis should be informed that priapism is a rare but documented potential side effect of cannabis use, a medical emergency requiring immediate treatment to prevent permanent erectile dysfunction, and that they should seek immediate medical attention for any erection lasting longer than 4 hours, as recommended by the American College of Physicians 1
Patients should be advised about the cardiovascular risks of THC concentrate use, and cautioned against combining THC with sedative medications or other substances that affect heart rate or blood pressure, as recommended by the American College of Physicians 1
High-risk populations, including adolescents and young adults (18-25 years), adults over 65 years, and children, should be aware of the potential adverse effects of marijuana consumption, as reported by the American College of Physicians 1

The American College of Physicians suggests considering screening for cannabis use patterns and frequency in patients with cardiovascular risk factors, and screening for cannabis use disorder, with a strength of evidence based on moderate to high-quality citations 2
The American Academy of Sleep Medicine recommends screening for cannabis use disorder and considering alternative evidence-based sleep interventions, such as cognitive behavioral therapy for insomnia (CBT-I), as cannabis use can alter normal sleep cycles and lead to poor sleep quality 1
The average concentration of THC has increased from 9% in 2008 to 17% in 2017, and cannabis concentrates can have THC levels of up to 70%, with higher potency associated with a greater risk of adverse effects, as reported by the American College of Physicians 1
Vaping cannabis presents unique risks, including acute lung injury, and edibles can cause more intense and prolonged effects due to delayed absorption, according to the American College of Physicians 1