Cannabis et syndrome coronarien aigu : étude de cas et revue systématique de la littérature

Abstract : Introduction : The use of cannabis is more and more widespread but its cardiovascular risks are not well determined. A 33-year-old patient without cardiovascular risk factors, occasional cannabis smoker, had acute coronary syndrome (ACS) 2 hours after cannabis use. The purpose of our study was to evaluate and synthesize the published evidence on the imputability of cannabis in the occurrence of ACS as well as the probable pathophysiological link that exists. Method : A systematic litterature review was performed. All articles suggesting a link between cannabis and ACS were included until 1 January 2018. Inclusion was based on a search algorithm used on PUBMed, Science Direct, Google Scholar, Cochrane Library, LiSSa and DOAJ. Results : 119 articles were included in our literature review: 64 case reports included 74 patients, 16 observational studies, and 39 experimental studies. A qualitative synthesis was realized. Cannabis caused dose-dependent tachycardia and decreased exercise time till angina. Contradictory results on coagulation and a certain but uncharacteristized involvement in atherosclerosis have been highlighted. There was a temporal relationship by an increased risk of ACS within one hour of cannabis use. Four retrspectives studies found a statistical association between cannabis use and ACS , especially among the youngest. However, these results are not supported by two prospective studies. Studies are limited by classification bias and inadequate assessment of exposure . The lack of systematic toxicological analysis can be a source of significant under-evaluation of the role of cannabis in the ACS. Its presence could reinforce a causal link with a dose effect and temporal relation. Determinants should be considered in the studies: the nature of the derived product, the concentration of THC, the route of exposure, the frequency and the cumulative use. Conclusion : The causal relationship between cannabis and ACS seems likely but the evidence is insufficient. Prospective epidemiological studies and experimental studies aimed at a better understanding of the role of the endocannabinoïd system in the regulation of the cardiovascular system are needed. Clinicians need to be more vigilant and inquire more about the use of cannabis, particularly among young adults and patients at high risk for ischemic heart disease.
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Submitted on : Monday, December 17, 2018 - 10:18:26 AM
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Jad Chehab. Cannabis et syndrome coronarien aigu : étude de cas et revue systématique de la littérature. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01957122⟩



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