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Adults utilizing medical cannabis for chronic pain, particularly those with cancer or cardiometabolic disease, may face a slightly elevated risk of developing arrhythmia, primarily atrial fibrillation/flutter, according to a Danish registry study published in the European Heart Journal on January 11, 2024. While cannabis use has been associated with increased cardiovascular risk, limited data exist regarding cardiovascular side effects with the use of medical cannabis for chronic pain.
The study, led by Dr. Anders Holt of Copenhagen University and Herlev-Gentofte Hospital, involved 5,391 patients with chronic pain (median age 59; 63% women) initiating first-time treatment with medical cannabis between 2018 and 2021. They were matched (1:5) to 26,941 control patients based on age, sex, chronic pain diagnosis, and concomitant use of other noncannabis pain medication.
Within 180 days, 42 medical cannabis users and 107 control participants developed arrhythmia, with atrial fibrillation/flutter being the most common. Medical cannabis users showed a slightly elevated risk for new-onset arrhythmia compared to nonusers (180-day absolute risk, 0.8% vs. 0.4%). The 180-day risk ratio with cannabis use was 2.07 (95% CI, 1.34-2.80), and the 1-year risk ratio was 1.36 (95% CI, 1.00-1.73).
Notably, adults with cancer or cardiometabolic disease had the highest risk for arrhythmia with cannabis use (180-day absolute risk difference, 1.1% and 0.8%). No significant association was found between medical cannabis use and the risk of acute coronary syndrome.
Despite the relative risk increase, the authors noted that absolute risks in the study population were modest. An editorial accompanying the study emphasized the need to contextualize medical cannabis as a therapeutic option based on patient comorbidities and potential vulnerability to side effects.
The study has limitations, including the possibility of residual confounding, lack of information on disease severity, clinical measures, blood tests, lifestyle factors, and unknown cannabis administration routes.
The research was funded by external and independent medical research grants, and Dr. Holt had no relevant disclosures. Some coauthors reported research grants and speakers’ fees from various drug companies.
