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Chronic Heart Failure. Surprise!

Chronic Heart Failure. Surprise!

I was rushed through the emergency department and admitted to the cardiac ward in the local hospital. Over the course of the next few days I was subjected to all sorts of tests and scans. Lying there alone and being pumped full of medications, the weight of my impending diagnosis hung in the sterile air.
Hayley Smith
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It was snowing on the morning of January 8th 2021. The covid pandemic and lockdowns were in full effect. I woke early that morning unable to take a proper breath. My heart was pounding, my pulse was racing and erratic, and I felt like I was suffocating. My partner called the paramedics. They arrived, took one look at me and bundled me into the ambulance.

I was rushed through the emergency department and admitted to the cardiac ward in the local hospital. Over the course of the next few days I was subjected to all sorts of tests and scans. Lying there alone and being pumped full of medications, the weight of my impending diagnosis hung in the sterile air.

Bob Clark
Bob Clark

Diagnosis. A Lifelong Condition.

After a week the first bit of news arrived and it was good. The MRI had confirmed that I had not suffered any form of heart attack. The blood vessels and valves in my heart looked good. No blockages or narrowed arteries. A weight felt lifted if only temporarily.

Unfortunately the relief was short-lived. My bubble burst just a few hours later with the bad news coming in the form of my echo-cardiogram results. Delivered coldly from behind a surgical mask it hit me like a freight train. I was told the left ventricle of my heart was operating at less than 15% efficiency and this was why my lungs had been full of fluids.

Immediate Effects

It was explained that I had a form of heart failure that was incurable and only manageable through careful lifestyle choices and a range of medications. No reason why was offered. I still don’t really know what caused it. Covid, genetics or stress? Maybe.

This was hard hitting news. It was one of the worst possible results and in that moment the fragility of my life became an undeniable reality. Big changes had to be made. Coffee, alcohol and even salt intake had to be strictly managed. Bananas, spinach and avocado even. No more than 2 litres of fluid intake per day. What happened to 8 glasses of water?

Adjusting to a New Lifestyle

I spent two more days in hospital and was released home with a sack full of pills and a steely resolve to have a complete rethink of my lifestyle. Not that my lifestyle was bad. I just had to up my game in all respects to be as ‘healthy as possible’. Reducing coffee, alcohol, red meat, salt and the rest proved to be no major issue. The tough one came later.

Reconsidering Cannabis Consumption

I had not even considered my weed smoking at this point as I had been too sick. It had always been my one real vice and I never thought I would be considering stopping at 42 years of age. Of course I had always moderated my consumption but I had enjoyed it too much to ever consider totally giving up. Was this what I now had to do?

Contemplating a High.

It took another few months of recovery before I really wanted to get high. During this time I had been hitting the research hard. I read everything I could find on the effects of cannabis on the cardiovascular system. To say they were anything but completely negative would not be true. To begin with I was very doubtful about my prospects of getting high again.

I just wanted to know if I could continue to enjoy something that I had spent 20 years doing with no ill effects. Some of the studies I looked at seemed to demonise it. Others were more neutral and non-committal as to any effects. Either way the confusion pushed my buttons and sparked my rebellious nature. I had to decide: To bud or not to bud?

The Dougie Experiment

Finally the lockdown restrictions were eased and the day had come. I had decided the only way to really know how weed would affect me was to try. I invited my friend Dougie over. He reluctantly agreed to help me experiment ‘a little bit’ provided we monitor my vitals with the monitoring kit I had. ECG, blood pressure, blood oxygen and heart rate. Before, during, after.

Combustion Failure

I told him we had a deal and set about recording my baseline levels. Everything was within range as was usual by this point in my recovery. We were good to go. Dougie rolled a small joint. He lit and passed it. I took one gentle hit and hacked, coughing badly. Passing it back my throat felt raw but I was determined so we decided to give it a few and try his bong. 

The bong hit was even worse. It felt so harsh and I didn’t like it one bit. I could tell from my body’s reaction that smoking was out and gave up dejectedly. We recorded all the levels a few times over the next hour or so.  My heart rate increased slightly and my blood oxygen dipped by 1% for a few minutes while I was coughing and spluttering, then it normalised.

There had not really been any adverse effects except my now sore throat and my morale. I was low and not feeling the promised high. I knew my throat just couldn’t take it. Luckily Dougie had an idea and left with a solemn promise to return with ‘something much better’.

Vaping: A Healthier Approach?

The next evening Dougie arrived early with a grin on his face and a sports bag containing a bunch of glass tubes that looked like lab gear. What was he up to? All sorts of illicit uses for this stuff crossed my mind and none of them involved cannabis. Within 5 minutes though he had it all assembled and a thing of great beauty appeared.

It was a Verdamper vape that he had borrowed from ‘a guy’. Out came his tin of buds and a small bag of gummies too. We chatted and decided that for the sake of science this should be a vaping test only. Testing protocol would be the same as before and unless it went badly wrong again we would split and save the gummies for another time.

I enjoy edibles but it was the ritual of preparing to smoke and the taste of the vapours from the herb that was really missing for me. I appreciate the work and craftsmanship that can go into a well rolled joint, or a nice looking bong or pipe. And I have to say the vape looked amazing!

A New Experience

We hooked up the power, loaded the bowl and waited on the heating element to get up to temperature. I took the first hit this time and held it waiting for the irritation and coughing fit. It didn’t come. It was just perfect. The hazy air passed into my lungs smoothly. It was cool and irritation free. I exhaled and pulled a bit more then sat back in my chair smiling at Dougie. 

The flavour I had missed so much was still there and, although subtler, was without the harshness of any smoke. It felt good in that familiar way. This time there were no problems whatsoever. My throat, lungs and heart all felt normal. The figures were all good. Nothing really changed this time. BP, blood oxygen, heart rate and my ECG still said no change.

I started to feel more confident that a little of this was not going to harm my health and before the night was out I had placed an order for my own Verdamper vape. We smoked a little bit more and kept testing. There were no changes at all and I was plenty high enough. The gummies stayed in the fridge and my vitals the next day were still just fine.

Moving Forward

The vape would now become my method of choice along with edibles. In two years I have suffered no ill effects consuming cannabis with my condition. I have monitored myself regularly and have found vaping and eating cannabis products in moderation makes no difference to my blood pressure and oxygen levels or to my heart rate and rhythms. 

From the huge impact of my diagnosis to finding a buzz again with my friends it’s been a real journey. It took a while but I’m happy, healthy as possible and enjoying the high life. Also, recently new research has come to light that will perhaps vindicate my decision making regardless of what my cardiologist says!

Conflicting Information. The Big Decision.

Why did I choose to ignore the general consensus and decide to see for myself what the impact of cannabis would be on my well-being? 

Questioning Research Methodologies

Well, I had looked at enough studies and data to see that very often these studies were based upon mathematical interpretation of existing general medical datasets and any association to cannabis was generally through anecdotal evidence. There was no direct testing. There also seemed to be a lot of inherent bias in the way data was collected.

Initial Research Findings: Cannabis and Cardiovascular Concerns

A study published in the Journal of the American College of Cardiology in 20171 suggested an increase in heart rate and blood pressure after cannabis use. It also suggested increased incidences of heart failure as well as alcohol and tobacco misuse in the cannabis user group. Sugary snacks aside, strangely enough cannabis users were at a lower risk of diabetes! I suppose that’s something at least!

Cannabis Use
n=316,397 (1.5%)
No Cannabis Use
n=20,499,215 (98.5%)
P value
Demographic
Age (years)
33.1
(32.9-33.2)
26.3
26.31-26.35
<0.001
Male gender (%) 60 38 <0.0001
Risk Factors
Diabetes Mellitus (%) 7.0 7.8 <0.0001
Hypertension (%) 19.9 15.7 <0.0001
Tobacco use (%) 47.2 11.4 <0.0001
Alcohol use (%) 28.1 3.8 <0.0001
Obesity (%) 7 6.5 <0.001
Cardiac Events
Heart Failure (%) 1.4 1.2 <0.01
Cerebrovascular Accident (%) 1.03 0.68 <0.0001
Coronary Artery Disease (%) 5 4.6 <0.0001
Sudden Cardiac Death (%) 0.21 0.17 <0.02
Atrial Fibrillation (%) 1.1 1.0 <0.08

Demographics, risk factors, and cardiac events in patients 18-55 years old with and without cannabis use

For me it’s important to remember that this was not a study that involved directly interviewing or testing cannabis users.  It was performed by manipulating data from the US National Hospital Inpatient database that had been recorded between 2009 and 2010.

Labelling Cannabis Users

In this dataset there are two recorded types of cannabis users. These are patients whose medical records show they were registered as either cannabis dependent or as engaging in nondependent cannabis abuse. Either way these were subcategories under the main ‘mental illness’ category. 

These codes were from the International Classification of Diseases2 guidelines which at the time only allowed for these two kinds of users. How many of these people were low level ordinary users? I would not expect to be registered as mentally ill or as an abuser or dependent of cannabis. I just like it. In my opinion these labels just didn’t seem relevant.

Reinforced Negative Findings or a Common Bias?

Another summary review paper published in the Journal of Clinical Medicine3 in 2020 makes for terrifying reading. It discusses the previous research on cannabis use and the cardiovascular system and paints a horrifying picture of broken health and cannabis abuse. 

From the opening abstract it states “Studies have shown that marijuana plays a role in thrombosis, inflammation, and atherosclerosis. Case reports have linked marijuana use to myocardial infarction, cardiac arrhythmias, cardiomyopathies, stroke, and arteritis.

The rest of the article paints an equally hopeless picture discussing the many cases and links between cannabis abuse and adverse cardiovascular events. Again the bulk of these studies seem to be based upon big data interpretation of a small subset of people diagnosed as being chronic or dependent users.

Origin of the Study Data

The reference sources in this 2020 review also convinced me that again perhaps these results were not so relevant to me. The studies heavily reference groups with a clear bias and anti-cannabis agenda. United Nations Office on Drugs and Crime. Substance Abuse and Mental Health Services Administration. National Institute on Drug Abuse. 

There truly are endless numbers of research papers stating that cannabis use is bad for your cardiovascular system in one way or another. Look hard enough though and contradictory evidence starts to stack up too.

Diving Deeper: Contradictory Findings?

A 2018 study published in the American Heart Association4 journal was titled ‘Among Patients With Heart Failure, Cannabis Use is Associated With Reduced Occurrence of Atrial Fibrillation and In-hospital Mortality’. The title sold it to me. Reduced occurrence of A-Fib. A potential killer for me! What? How! It sounded too good to be true. Well perhaps it is.

Once again this study was based upon the US Nationwide Inpatient Sample database. This time they narrowed the dataset down to patients older than 18 years admitted with the primary diagnosis of heart failure between 2007 – 2014. The same ICD codes used to label either dependance or abuse. The results entirely contradicted my previous research.

Further Conflicting Information

There are plenty more published articles, reviews and studies stating that there are little to no negative effects of cannabis on the cardiovascular system. In a review first published in the Journal of Clinical Pharmacology5 during 2014 the following conclusion was reached.

Although several mechanisms exist by which marijuana use might contribute to the development of chronic cardiovascular conditions or acutely trigger cardiovascular events, there are few data regarding marijuana/THC use and cardiovascular disease outcomes. A large cohort study showed no association of marijuana use with cardiovascular disease hospitalisation or mortality.

The article did also state that patients with existing cardiovascular issues or who are at high risk for the development of them should be cautioned about the potential risks of cannabis use as a precursor for adverse events. It suggested more studies were needed on cardiovascular diseases and risk factors in relation to cannabis use.

Navigating Conflicting Studies

This is a small subset of my reading. There’s a heap more information out there and I was very confused by the time I got to this point. There had been a lot to take onboard. There had been so many contradictions in the conclusions of these studies. Something was not quite ringing true with me. It just didn’t make any sense.

For instance, if I was understanding it correctly, according to the 2017 study of the inpatient database cannabis abuse may well put you in hospital due to A-Fib. Inversely, according to the 2018 study of a slightly different subset from the same source, cannabis users were less likely to experience A-Fib once admitted to the hospital. Surely both couldn’t be true.

Confused Rebellion. Possible Vindication?

All of this conflicting information became too much for my brain. All of the hours of researching and reading seemed pointless. I could only conclude that nobody really knew what the result of my using cannabis would be. This so-called research was all just guesswork and extrapolation!

Empowered and emboldened by my ignorance I rebelled. I had wasted weeks trying to figure this out and ultimately all I had come to understand was that there was no common consensus. My brain was telling me why not just go for it. Start low and slow. If coffee and beer were ok in moderation then why not weed. Just a little. What could go wrong?!

My Body, My Choice

More than 2 years later I’m glad that I tried. Since I learned the hard way to stop burning my herb I have never had any negative effects from vaping cannabis or consuming its derivative products in moderation. As well as this recently there has been a flurry of research with more positive outcomes. I might even say that they have perhaps helped to vindicate my decision.

Emerging Research and New Perspectives

In an edition of Toxicology Report6 from April 2023 a team of researchers from Thailand published the results of their analysis of 20 previous studies with a patient sample size of over 183 million people. Their findings were pretty much exactly in line with what I had come to understand about previous research. Most importantly of all they found that the risk of adverse cardiovascular events is not significantly increased with cannabis use.

They discuss the fundamental differences between previous studies and their disparate results. The variety of results they say can be explained by differences in the preparation and method of use, the quantity used and duration of use as well as the amount of time after use so we should be cautious drawing conclusions as further investigation is needed.

Further Positive Confirmation

Similarly, in a November 2023 study published in the Circulation of Cardiovascular Quality Outcomes7, US adults without cardiovascular disease were sampled from the National Health And Nutrition Examination Survey database (2005-2018). These included subjects who had self-reported cannabis use. Sociodemographic and lifestyle factors, including tobacco use were accounted for in the analysis and results.

Another data analysis exercise that this time no association between cannabis use and increased cardiovascular risk factors was found. The team did conclude that further research is needed to explore the effects of cannabis use on cardiovascular health but found limited evidence in the dataset they explored.

No End to the Conflicting Data

There has not been a complete shift in ethos and it should be noted that there are still more studies with a negative view on cannabis and health than there are positive. It was recently reported in the journal Addiction8 that a study in Canada found cannabis users had a 60% higher risk of adverse cardiovascular events than those without cannabis use disorder.

Considering the Right Balance

For myself, confusion does still reign when it comes to interpreting the research and I can only speak for what works for me alone. In the absence of definitive information I made a choice and thankfully it worked. Moderation is playing a big part in the long term success of my strategy. I don’t overeat or drink too much alcohol and I certainly don’t binge on weed.

We should remember that all sorts of factors contribute to the unique nature of our experiences with cannabis. It’s critical for us all to listen to our bodies, understand any changes or discomfort and to communicate openly with our doctors.

Personal Decision Making

Striking a balance between cannabis use and overall health goals is essential. We should all carefully consider our health objectives and tailor any cannabis use to align with these goals. It has to involve a thoughtful, educated approach that takes into account our health conditions, lifestyle, and preferences. Please. Please. Do your own research!

Remember frequent communication with healthcare professionals is absolutely essential. Regular check ups allow for ongoing assessment of your cardiac health and will ensure any issues are identified and resolved. Adjustments to your cannabis regimen can be made as needed so that it continues to support your overall goals without compromising your health.

References

  1. Kalla, A, Krishnamoorthy, P, Gopalakrishnan, A. et al. CANNABIS USE PREDICTS RISKS OF HEART FAILURE AND CEREBROVASCULAR ACCIDENTS: RESULTS FROM THE NATIONAL INPATIENT SAMPLE. J Am Coll Cardiol. 2017 Mar, 69 (11_Supplement) 1784 ↩︎
  2. Reference to the wikipedia page on International Classification of Diseases Revision 9 ↩︎
  3. Latif, Z.; Garg, N. The Impact of Marijuana on the Cardiovascular System: A Review of the Most Common Cardiovascular Events Associated with Marijuana Use. J. Clin. Med. 2020, 9, 1925. https://doi.org/10.3390/jcm9061925 ↩︎
  4. Oluwole Adegbala, Akintunde Akinjero, Adeyinka Adejumo, Samson Alliu, Emmanuel Akintoye, Eseosa Edo-Osagie and Tomi Akinyemiju Originally published8 Jun 2018Circulation. 2017;136:A14752 Abstract 14752: Among Patients With Heart Failure, Cannabis Use is Associated With Reduced Occurrence of Atrial Fibrillation and In-hospital Mortality; Evidence From the Nationwide Survey 2007-2014 ↩︎
  5. Stephen Sidney MD, MPH First published: 16 January 2014 Cardiovascular Consequences of Marijuana Use https://doi.org/10.1002/j.1552-4604.2002.tb06005.x ↩︎
  6. Nonthikorn Theerasuwipakorn, Somcha https://doi.org/10.1016/j.toxrep.2023.04.011.i Prechawat, Ronpichai Chokesuwattanaskul, Noppachai Siranart, Apichai Marsukjai, Suthimon Thumtecho, Voravut Rungpradubvong, Cannabis and adverse cardiovascular events: A systematic review and meta-analysis of observational studies, Toxicology Reports, Volume 10, 2023  ↩︎
  7. Kainat A, Onyeaka HK, Aiyer A. Comparison of Atherosclerotic Cardiovascular Risk Factors and Cardiometabolic Profiles Between Current and Never Users of Marijuana. Circ Cardiovasc Qual Outcomes. 2023 Nov;16(11):e009609. doi: 10.1161/CIRCOUTCOMES.122.009609. Epub 2023 Oct 20. PMID: 37860878. ↩︎
  8. Alhassan HA, Akunor H, Howard A, Donohue J, Kainat A, Onyeaka HK, Aiyer A. Comparison of Atherosclerotic Cardiovascular Risk Factors and Cardiometabolic Profiles Between Current and Never Users of Marijuana. Circ Cardiovasc Qual Outcomes. 2023 Nov;16(11):e009609. doi: 10.1161/CIRCOUTCOMES.122.009609. Epub 2023 Oct 20. PMID: 37860878. ↩︎
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