Ask the Doctors April 2018 Issue

Ask The Doctors: April 2018

Michael Rocco, MD

Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic

Q: A friend is using electronic cigarettes to quit smoking and claims it is a safe alternative. Is this true?

A: Cigarette smoking contributes to 480,000 deaths per year in the U.S. Burning tobacco releases thousands of chemicals, at least 70 of which are known to be carcinogenic. Therefore, finding a safer alternative is a goal.

Since millions are already vaping or using e-cigarettes, it is important to understand their health effects. A recent report from the National Academies of Sciences, Engineering and Medicine revealed that little is known about the long-term health effects of these cigarette substitutes. However, the writers concluded that although e-cigarettes are not without risk, they contain fewer toxic substances, show less biological activity than tobacco cigarettes in animal and human studies and are likely to be substantially less harmful than tobacco.

The authors had good news about using e-cigarettes as a smoking cessation aid, so long as users were not smoking regular cigarettes simultaneously. They did find vaping can be addictive, and nicotine levels vary widely from product to product.

If you have not been been able to quit smoking with other methods, e-cigarettes may be a reasonable option, so long as you are not pregnant, you discontinue all use of other tobacco products and you use e-cigarettes only for a short, defined period of time. If you are a nonsmoker, particularly if you are young, you should avoid vaping because it may lead to nicotine dependency and use of tobacco cigarettes.

Q: Many states have legalized marijuana for medical use. Is it safe to use marijuana if you have a history of heart disease?

A: At this time, 29 states and the District of Columbia have legalized medical marijuana, and eight states and the District of Columbia have legalized marijuana for recreational use. It’s past time to understand its side effects.

Medical marijuana differs from recreational marijuana in that THC, the chemical responsible for making users “high,” has been removed. Medical marijuana can be smoked, vaporized, taken as a pill, liquid or added to foods. The FDA has not approved the marijuana plant as medicine, but has approved pills containing cannabinoid chemicals (dronabinol and nabilone) to treat nausea and boost appetite. Marijuana products are being examined in clinical trials of treatments for multiple sclerosis, Parkinson’s disease, chronic pain and inflammation, seizures, substance abuse, nausea and decreased appetite associated with chemotherapy and AIDS. Fewer studies of marijuana in patients with heart disease exist, and those that do are of questionable quality.

We do know that marijuana can increase heart rate and blood pressure, which may be detrimental to patients with heart disease.

Claims that marijuana has cardiovascular benefits and may even improve blood sugar and cholesterol levels do not appear to be validated. A review of 24 studies conducted between 1975 and 2017 published online in the Annals of Internal Medicine Jan. 23, 2018, found that evidence of benefit or risk was insufficient to draw valid conclusions. The effects of marijuana on diabetes and blood lipid levels was unclear in 13 studies. The 11 studies that examined the impact of marijuana on heart attack, stroke and death were equally inconclusive. Only one study that specifically looked at marijuana as a potential trigger for heart attack did find an increased risk within the first hour after smoking.

At this time, we would have to conclude that the cardiovascular impact of marijuana is unknown. If you have heart disease, the decision to use marijuana for medical or recreational reasons should be based on a discussion with your physician. 

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