Association Between Recreational Cannabis Use and Cardiac Structure and Function.

Cannabis is one of the most widely produced and consumed recreational drugs in the world, with over 192 million global users ([1][1]). The World Health Organization has warned against the potential harmful health effects of nonmedicinal cannabis use and highlighted the need for more research


Cannabis Use and Cardiac Structure and Function
Cannabis is one of the most widely produced and consumed recreational drugs in the world, with over 192 million global users (1). The World Health Organization has warned against the potential harmful health effects of nonmedicinal cannabis use and highlighted the need for more research assessing the link between cannabis smoking and cardiovascular disease (CVD) in adults (2). Legalization of cannabis is increasing. In the United States, recreational cannabis use is legal in 12 states and has been decriminalized in many others. Discussions on the potential public health impact are hampered by gaps in evidence and variable quality of available data. Little or no mention of cannabis exists in CVD risk assessments or lifestyle advice guideline (3,4).
We studied the association of cannabis use with cardiac structure and function using cardiovascular magnetic resonance (CMR)  To the best of our knowledge, this is the first study to systematically report alterations in cardiac

Right ventricle Right atrium Left atrium Left ventricle
Regular cannabis use was independently associated with adverse changes in left ventricle size and subclinical dysfunction compared with rare/never cannabis use.
*Changes remain significant after multivariable adjustment. #Changes remain significant after adjustment for age and sex.  The funders provided support in the form of salaries for authors as detailed but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Dr. Petersen provides consultancy to Circle Cardiovascular Imaging Inc., Calgary, Canada, and Servier. Dr. Jensen has served as consultant, on advisory boards, or as invited speaker for AstraZeneca, Novo Nordisk, Novartis, and GE. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

World Health Organization. The Health and Social Effects of Nonmedical
Cannabis Use. Available at: https://www.who.int/substance_abuse/ publications/msbcannabis.pdf. Accessed February 24, 2018. Assuming the observed overall complication rate of 7.3% and the sample size of the study, differences in complication rates of 8% (i.e., 3.3% vs. 11.3%) or larger could have been detected (power 80%, type I error ¼ 0.05; 2-sided).
Procedural complications occurred less often in women in the CT group compared with the ICA group (CT: 1.1% vs. ICA: 11.5%). Procedural complications were similar in men in both groups (CT: 7.6% vs. ICA: 9.5%). Major procedural complications were uncommon in the CT and ICA group in both sexes ( Table 1).
Minor procedural complications occurred less often in women in the CT group compared with the ICA group ( Table 1). The interaction sex study arm regarding procedural complication was p ¼ 0.072.
The number of any events at long-term follow-up at 3.3 years was similar in women and men in both groups ( Table 1).
This study is limited by its single-center design and the small total number of adverse events. Although earlier studies revealed differences between women and men regarding the prevalence and symptoms of CAD, ours is the first study analyzing sex differences in terms of outcomes of diagnostic procedures (CT and ICA). This study shows that women with atypical chest pain and a clinical indication for coronary evaluation may benefit from a strategy based on CT instead of ICA, specifically due to a reduction in minor procedural complications.
Possible reasons for these results are: 1. Having a lower pretest probability of disease than men and a lower rate of complex diseases women are expected to benefit less from initial ICA.
2. Women with obstructive CAD have more comorbidities, present with atypical symptoms, and tend