Dear Cannabis RN,
I read a recent study which suggested that cannabis can be bad for people with heart disease. My husband has afib {atrial fibrillation}. He also had a heart attack and a stent placed in February of 2019. Is cannabis bad for people with heart disease?
-A concerned wife
Wow what a great question! Heart disease is the most common cause of death for Americans and cannabis is the fastest growing consumer product in the US. Due to the sheer number of people’s health potentially affected by this information, we are wise to discuss the issue. Before we dive in, a few clarifications: this article does not represent medical advice, it is for informational purposes only. heart disease is an umbrella term that has within it many different conditions, so for clarity's sake, we're going to talk primarily about the disease that causes many heart attacks: coronary artery disease. Instead of asking if cannabis is harmful for people with heart disease, let us pose a different question: Can cannabis be a gateway to wellness for individuals dealing with heart disease, and if so, how?
HEART ATTACKS, STATINS, AND THE GREAT CHOLESTEROL MYTH
When I worked at a large cardiology practice associated with a hospital, I had a patient named Roy who was in his 60s and had suffered a heart attack. In advance of his annual appointment he sent me an email asking me to print out a research study on coronary artery disease and give it to his physician to read.
I replied to the email and told him I would be happy to have her to look at it.
Unfortunately, the cardiologist wasn’t very keen on his request.
I can still see her raised eyebrows and quizzical expression on her face as she laughed and replied, “Yeah right like I have time to read a 30-page research study prior to his 15-minute appointment.” She walked away and dropped the paper in the recycling.
I fished it out, took it home and read it instead.
What I read turned my world upside down and called into question many of the underlying assumptions about heart disease that I had taken for granted. It completely shattered my confidence in how I was caring for and educating patients who had cardiovascular disease.
As healthcare providers, we are taught to accept the established paradigm without question, which presents the cause of cardiovascular disease as if it’s beyond question. In actuality, the science has continued to evolve so that decades after research first commenced, we have an updated understanding. After reading this study (and dozens of others after), I realized that contrary to what I learned in school, and contrary to the manner in which I was being urged to practice, one of the established risk factors-high cholesterol- was less of a cause and more of a symptom caused by the body’s attempt to heal itself from chronic unchecked inflammation.
The study concluded that one of the mainstays of heart attack treatment and prevention, lowering cholesterol through using of statin therapy, was not helpful in reducing death from heart disease. Quite the opposite, it showed an association between lower cholesterol levels and higher risk of death, especially in people over 65.
I assumed, like most healthcare providers that cholesterol was a risk factor and potential cause of heart attacks. For decades, we have been educating people that cholesterol was a “bad substance” that could clog the arteries of the heart and cause heart attacks. Federal agencies and healthcare institutions supported this view that eating cholesterol was bad for your health.
The low-fat diet craze grew out of this incomplete picture of heart disease. Then, the pharmaceutical industry got involved in the research. They created a whole class drugs called statins, to reduce cholesterol! Statins are some of the most commonly prescribed medications here in the US (1 in 4 people over 45 years old take a statin), and they gross over 20 billion dollars annually.
Here’s the problem with the story: cholesterol does not cause heart attacks! Research suggests that the main cause of heart attacks is uncontrolled, chronic inflammation. Cholesterol is one substance that the body makes to help heal damaged and inflamed arteries.
When the interior lining of the arteries is damaged (usually by a combination of factors that includes an ongoing inflammatory response and high blood pressure), the cholesterol adheres to the damaged arterial wall, kind of like a scab. Instead of calling it a scab, we call it plaque. The plaque can build up over the years, and it can break loose. Either way, you’re on the road to eventually suffering a heart attack. Lowering cholesterol without addressing the underlying reason it is building up in the arteries essentially means we are preventing the body from healing itself.
When I talked to Roy about this after his appointment, I thanked him for sending the article and told him that I had read it and I understood his point of view. He said "every time I come in for my annual she looks at my labs and tells me I need to take a statin. I tell her I'm not interested and then she tells me to come back in a year."
I understood his frustration. I gave him the name of an integrative cardiologist who he might may have better luck working with on diet and lifestyle factors.
PUTTING THE PIECES TOGETHER
You’ll very likely find studies on cannabis and heart disease which insinuate that cholesterol is a risk factor for heart disease, or at the very least is harmful. You likely find studies concluding that cannabis consumption is also a risk factor.
However, both conclusions about the risk factors that lead to heart attacks are hotly debated “theories” in the medical community. One take away from studying human physiology: it is very rare for any substance produced in the human body to be inherently good or bad; everything the body makes and uses has its rightful place and purpose, from sugar, fat, and protein to hormones, neurotransmitters, and endocannabinoids. Cholesterol has its place in the greater symphony of human physiology and cannabinoids are no different. Even in people who have had heart attacks.
Instead of asking if cannabis is harmful for people with heart disease, I want to suggest we ask different question: Can cannabis be a gateway to wellness for individuals dealing with heart disease, and if so, how?
To answer your question yes, research has shown that cannabis use is associated with a greater risk of heart disease in some individuals. However, research has also shown that cannabis can help address some of the underlying root causes of heart disease including: inflammation, spasm, clotting, immune function, and metabolism. In addition, cannabis consumption (and this study was based on smoking) was found to be associated with a decreased risk of heart attack in individuals over 65.
I imagine that after your visit with Dr. Cohen you’ll have a better idea of how to incorporate cannabis into your daily routine in a way that benefits your heart and support you in healing from and living with heart disease. As always, this article is not to be taken as medical advice and is for informational purposes only. In closing here are some general education tips:
1.) THC can cause increased heart rate and anxiety, two side effects that could affect your heart.
2.) Using CBD combined with THC can decrease the risk of experiencing negative side effects, but it does not prevent them entirely.
3.) Many people with chronic atrial fibrillation take blood thinners to decrease their risk of stroke, and cannabis can interact with some of these medications in a way that needs to be monitored by a healthcare professional.
4.) Smoking is considered a risk factor for heart disease, as you probably know, and we don’t recommend that anyone smoke cannabis (or anything for that matter). We recommend an alternative delivery method that is less harmful than smoking such as vaporizing cannabis flower.
5.) CBD is an anti-inflammatory which may positively impact the heart through addressing the underlying cause of coronary artery disease.
Mainstream healthcare has been on the wrong side of science and history in recent years when it comes to treating chronic and preventative disease, but that doesn't mean we can't educate those who seek deeper answers. The confusion evidenced in the mainstream healthcare system about both the cause of cardiovascular disease and the place of cannabis medicine in its prevention is a result of decades of misinformation. The intention behind questioning accepted science is part of science itself: when we publicize the research that contradicts the “only acceptable” view of an issue, we begin to create a narrative change, which is essential to getting closer to the truth. Through accepting that we do not know the whole story about cannabis or cholesterol, we can we update what we do know, and we can move forward. That is this ethical framework of science, and that is the progress of science. We must continue to update the body of knowledge, as if our lives depend on it.
This update will help drive innovation in healthcare and help us to restore cannabis (and cholesterol) to their rightful place in our understanding of the human body and in the conceptual framework of healthcare providers.
-Amy Silverman, RN
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