Clinical Investigation
Acute Ischemic Heart Disease
An exploratory prospective study of marijuana use and mortality following acute myocardial infarction

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Background

The relationship of marijuana use with coronary heart disease, including prognosis among patients with coronary heart disease, is uncertain.

Methods

We conducted an inception cohort study of 1913 adults hospitalized with myocardial infarction at 45 US hospitals between 1989 and 1994, with a median follow-up of 3.8 years. We ascertained total mortality according to self-reported marijuana use in the preceding year.

Results

A total of 52 patients reported marijuana use during the prior year, and 317 patients died during follow-up. Compared with nonuse, marijuana use less than weekly was associated with a hazard ratio of 2.5 (95% CI, 0.9-7.3). The corresponding hazard ratio for weekly use or more was 4.2 (95% CI, 1.2-14.3). The age- and sex-adjusted hazard ratios associated with any use were 1.9 (95% CI, 0.6-6.3) for cardiovascular mortality and 4.9 (95% CI, 1.6-14.7) for noncardiovascular mortality. In a comparison of 42 marijuana users and 42 other patients matched on propensity scores, there were 6 deaths among marijuana users and one among non-users (log-rank P = .06).

Conclusions

These preliminary results suggest possible hazards of marijuana for patients who survive acute myocardial infarction. Although marijuana use has not been associated with mortality in other populations, it may pose particular risk for susceptible individuals with coronary heart disease.

Section snippets

Onset Study enrollment and data collection

The Onset Study was conducted in 45 community and tertiary care medical centers. Between August 1989 and September 1994, 1935 patients (601 women and 1334 men) were interviewed a median of 4 days after sustaining a MI. Trained research interviewers identified eligible patients by reviewing coronary care unit admission logs and patient charts. For inclusion, patients were required to have a creatine kinase level above the upper limit of normal for each center, positive MB isoenzymes, an

Patient characteristics

Table I shows the characteristics of the Onset Study participants according to marijuana use. A total of 52 patients (2.7%) reported marijuana use in the preceding year. As expected,5 marijuana users tended to be younger than other patients; had heavier usual alcohol consumption; and were more likely to be male, current smokers, and divorced or separated. Among marijuana users, the reported median frequency of use was once every 2 weeks.

Marijuana use and mortality

A total of 317 patients died during a median of 3.8 years

Discussion

In this preliminary prospective cohort study of early survivors of AMI, marijuana use, as measured at the time of hospitalization, was associated with 3-fold higher mortality after infarction. There was a gradient in risk, with the highest risk of death among individuals who used marijuana most frequently, and the risk was entirely unchanged by multivariate adjustment.

Marijuana use has important cardiovascular effects that could pose risk for patients with coronary heart disease. Among the

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    This study was supported by grants R01HL41016 from the National Heart, Lung, and Blood Institute, Bethesda, MD; R21AA014900 from the National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD; and 9630115N from the American Heart Association, Dallas, TX, for the Onset Study.

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