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Original article
peer-reviewed

Recreational Marijuana Use and Acute Myocardial Infarction: Insights from Nationwide Inpatient Sample in the United States



Abstract

Background

Marijuana is a widely used recreational substance. Few cases have been reported of acute myocardial infarction following marijuana use. To our knowledge, this is the first ever study analyzing the lifetime odds of acute myocardial infarction (AMI) with marijuana use and the outcomes in AMI patients with versus without marijuana use.

Methods

We queried the 2010-2014 National Inpatient Sample (NIS) database for 11-70-year-old AMI patients. Pearson Chi-square test for categorical variables and Student T-test for continuous variables were used to compare the baseline demographic and hospital characteristics between two groups (without vs. with marijuana) of AMI patients. The univariate and multivariate analyses were used to assess and compare the clinical outcomes between two groups. We used Cochran–Armitage test to measure the trends. All statistical analyses were executed by IBM SPSS Statistics 22.0 (IBM Corp., Armonk, NY). We used weighted data to produce national estimates in our study.

Results

Out of 2,451,933 weighted hospitalized AMI patients, 35,771 patients with a history of marijuana and 2,416,162 patients without a history of marijuana use were identified. The AMI-marijuana group consisted more of younger, male, African American patients. The length of stay and mortality rate were lower in the AMI-marijuana group with more patients being discharged against medical advice. Multivariable analysis showed that marijuana use was a significant risk factor for AMI development when adjusted for age, sex, race (adjusted OR 1.079, 95% CI 1.065-1.093, p<0.001); adjusted for age, female, race, smoking, cocaine abuse (adjusted OR 1.041, 95% CI 1.027-1.054, p<0.001); and also when adjusted for age, female, race, payer status, smoking, cocaine abuse, amphetamine abuse and alcohol abuse (adjusted OR: 1.031, 95% CI: 1.018-1.045, p<0.001). Complications such as respiratory failure (OR 18.9, CI 15.6-23.0, p<0.001), cerebrovascular disease (OR 9.0, CI 7.0-11.7, p<0.001), cardiogenic shock (OR 6.0, CI 4.9-7.4, p<0.001), septicemia (OR 1.8, CI 1.5–2.2, p<0.001), and dysrhythmia (OR 1.8, CI 1.5-2.1, p<0.001) were independent predictors of mortality in AMI-marijuana group.

Conclusion

The lifetime AMI odds were increased in recreational marijuana users. Overall odds of mortality were not increased significantly in AMI-marijuana group. However, marijuana users showed higher trends of AMI prevalence and related mortality from 2010-2014. It is crucial to assess cardiovascular effects related to marijuana overuse and educate patients for the same.



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Original article
peer-reviewed

Recreational Marijuana Use and Acute Myocardial Infarction: Insights from Nationwide Inpatient Sample in the United States


Author Information

Rupak Desai Corresponding Author

Research Coordinator, Atlanta Veterans Affairs Medical Center

Upenkumar Patel

Public Health, National University

Shobhit Sharma

Biology, Texas State University

Parth Amin

Department of Internal Medicine, Wellstar Atlanta Medical Center

Rushikkumar Bhuva

Internal Medicine, Canton Medical Education Foundation

Malav S. Patel

Department of Healthcare Administration and Health Informatics, Marshall University

Nitin Sharma

Department of Health Informatics, Marshall University

Manan Shah

Internal Medicine, University of Texas, Houston

Smit Patel

Department of Neurology, University of Connecticut Health Center

Sejal Savani

New York University

Neha Batra

Pediatrics, St. Joseph Regional Medical Center

Gautam Kumar

Department of Medicine, Division of Cardiology, Atlanta Veterans Affairs Medical Center and Emory University School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

Recreational Marijuana Use and Acute Myocardial Infarction: Insights from Nationwide Inpatient Sample in the United States


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Original article
peer-reviewed

Recreational Marijuana Use and Acute Myocardial Infarction: Insights from Nationwide Inpatient Sample in the United States

Rupak Desai">Rupak Desai , Upenkumar Patel">Upenkumar Patel, Shobhit Sharma">Shobhit Sharma, Parth Amin">Parth Amin, Rushikkumar Bhuva">Rushikkumar Bhuva, Malav S. Patel">Malav S. Patel, Nitin Sharma">Nitin Sharma, Manan Shah">Manan Shah, Smit Patel">Smit Patel, Sejal Savani">Sejal Savani, Neha Batra">Neha Batra, Gautam Kumar">Gautam Kumar

  • Author Information
    Rupak Desai Corresponding Author

    Research Coordinator, Atlanta Veterans Affairs Medical Center

    Upenkumar Patel

    Public Health, National University

    Shobhit Sharma

    Biology, Texas State University

    Parth Amin

    Department of Internal Medicine, Wellstar Atlanta Medical Center

    Rushikkumar Bhuva

    Internal Medicine, Canton Medical Education Foundation

    Malav S. Patel

    Department of Healthcare Administration and Health Informatics, Marshall University

    Nitin Sharma

    Department of Health Informatics, Marshall University

    Manan Shah

    Internal Medicine, University of Texas, Houston

    Smit Patel

    Department of Neurology, University of Connecticut Health Center

    Sejal Savani

    New York University

    Neha Batra

    Pediatrics, St. Joseph Regional Medical Center

    Gautam Kumar

    Department of Medicine, Division of Cardiology, Atlanta Veterans Affairs Medical Center and Emory University School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: November 03, 2017

    DOI

    10.7759/cureus.1816

    Cite this article as:

    Desai R, Patel U, Sharma S, et al. (November 03, 2017) Recreational Marijuana Use and Acute Myocardial Infarction: Insights from Nationwide Inpatient Sample in the United States . Cureus 9(11): e1816. doi:10.7759/cureus.1816

    Publication history

    Received by Cureus: October 27, 2017
    Peer review began: October 31, 2017
    Peer review concluded: November 01, 2017
    Published: November 03, 2017

    Copyright

    © Copyright 2017
    Desai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background

Marijuana is a widely used recreational substance. Few cases have been reported of acute myocardial infarction following marijuana use. To our knowledge, this is the first ever study analyzing the lifetime odds of acute myocardial infarction (AMI) with marijuana use and the outcomes in AMI patients with versus without marijuana use.

Methods

We queried the 2010-2014 National Inpatient Sample (NIS) database for 11-70-year-old AMI patients. Pearson Chi-square test for categorical variables and Student T-test for continuous variables were used to compare the baseline demographic and hospital characteristics between two groups (without vs. with marijuana) of AMI patients. The univariate and multivariate analyses were used to assess and compare the clinical outcomes between two groups. We used Cochran–Armitage test to measure the trends. All statistical analyses were executed by IBM SPSS Statistics 22.0 (IBM Corp., Armonk, NY). We used weighted data to produce national estimates in our study.

Results

Out of 2,451,933 weighted hospitalized AMI patients, 35,771 patients with a history of marijuana and 2,416,162 patients without a history of marijuana use were identified. The AMI-marijuana group consisted more of younger, male, African American patients. The length of stay and mortality rate were lower in the AMI-marijuana group with more patients being discharged against medical advice. Multivariable analysis showed that marijuana use was a significant risk factor for AMI development when adjusted for age, sex, race (adjusted OR 1.079, 95% CI 1.065-1.093, p<0.001); adjusted for age, female, race, smoking, cocaine abuse (adjusted OR 1.041, 95% CI 1.027-1.054, p<0.001); and also when adjusted for age, female, race, payer status, smoking, cocaine abuse, amphetamine abuse and alcohol abuse (adjusted OR: 1.031, 95% CI: 1.018-1.045, p<0.001). Complications such as respiratory failure (OR 18.9, CI 15.6-23.0, p<0.001), cerebrovascular disease (OR 9.0, CI 7.0-11.7, p<0.001), cardiogenic shock (OR 6.0, CI 4.9-7.4, p<0.001), septicemia (OR 1.8, CI 1.5–2.2, p<0.001), and dysrhythmia (OR 1.8, CI 1.5-2.1, p<0.001) were independent predictors of mortality in AMI-marijuana group.

Conclusion

The lifetime AMI odds were increased in recreational marijuana users. Overall odds of mortality were not increased significantly in AMI-marijuana group. However, marijuana users showed higher trends of AMI prevalence and related mortality from 2010-2014. It is crucial to assess cardiovascular effects related to marijuana overuse and educate patients for the same.



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Create a free account to continue reading this article.

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Rupak Desai

Research Coordinator, Atlanta Veterans Affairs Medical Center

For correspondence:
drrupakdesai@gmail.com

Upenkumar Patel, M.B.B.S., M.P.H

Public Health, National University

Shobhit Sharma, Ph.D., Faculty

Biology, Texas State University

Parth Amin

Department of Internal Medicine, Wellstar Atlanta Medical Center

Rushikkumar Bhuva

Internal Medicine, Canton Medical Education Foundation

Malav S. Patel, M.D., M.H.A., M.H.I.T.

Department of Healthcare Administration and Health Informatics, Marshall University

Nitin Sharma, M.D.

Department of Health Informatics, Marshall University

Manan Shah, M.B.B.S

Internal Medicine, University of Texas, Houston

Smit Patel

Department of Neurology, University of Connecticut Health Center

Sejal Savani

New York University

Neha Batra

Pediatrics, St. Joseph Regional Medical Center

Gautam Kumar

Department of Medicine, Division of Cardiology, Atlanta Veterans Affairs Medical Center and Emory University School of Medicine

Rupak Desai

Research Coordinator, Atlanta Veterans Affairs Medical Center

For correspondence:
drrupakdesai@gmail.com

Upenkumar Patel, M.B.B.S., M.P.H

Public Health, National University

Shobhit Sharma, Ph.D., Faculty

Biology, Texas State University

Parth Amin

Department of Internal Medicine, Wellstar Atlanta Medical Center

Rushikkumar Bhuva

Internal Medicine, Canton Medical Education Foundation

Malav S. Patel, M.D., M.H.A., M.H.I.T.

Department of Healthcare Administration and Health Informatics, Marshall University

Nitin Sharma, M.D.

Department of Health Informatics, Marshall University

Manan Shah, M.B.B.S

Internal Medicine, University of Texas, Houston

Smit Patel

Department of Neurology, University of Connecticut Health Center

Sejal Savani

New York University

Neha Batra

Pediatrics, St. Joseph Regional Medical Center

Gautam Kumar

Department of Medicine, Division of Cardiology, Atlanta Veterans Affairs Medical Center and Emory University School of Medicine