Could the future of caring for patients with cardiovascular disease involve cannabis treatment?
Cardiovascular disease (CVD) is an umbrella term for several independent conditions, including coronary heart disease, stroke, and heart failure. Globally, CVD issues are the number one cause of death for men and women. In the U.S., approximately seventy percent of men and seventy-one percent of women between the ages of 60 and 79 have some form of CVD. Importantly, these estimates rise to eighty-three percent for men and eighty-seven percent for women in those greater than eighty years old. Based on these statistics, an aging population means a greater incidence of CVD. With cannabis consumption and rates of CVD on the rise, could the future of caring for patients with CVD involve cannabis treatment?
Unfortunately, for some CVD patients, pain is a significant burden to everyday living and recovery. Pain treatment can involve commonly prescribed medications such as opioids. However, more and more seniors are experimenting with cannabis to manage their pain.
Pain Management Speeds up Improved Functional Performance
In a study published in Home Healthcare Now (2020), 1)Kang, Y., Sheng, X., Stehlik, J., & Mooney, K. (2020). Identifying Targets to Improve Heart Failure Outcomes for Patients Receiving Home Healthcare Services: The Relationship of Functional Status and Pain. Home Healthcare Now, 38(1), 24-30 researchers demonstrated the importance of pain-relief for CVD patients in a home healthcare setting. The researchers collected data on a sample of patients (eighty-eight percent senior citizens) with a diagnosis of heart failure. Also those who had been discharged from an in-patient facility and received home healthcare. Their goal was to explore the relationship between functional health status and pain to provide insight into preventing re-hospitalization.
Following home healthcare, some patients in the sample experienced significant improvements in activities of daily living. These functional improvements were heavily influenced by activity-interfering pain following treatment. Specifically, patients who reported activity-interfering pain daily improved the least. While patients who reported no activity interfering pain had the greatest improvement in functional performance. Further, the authors concluded that “improving functional performance of home healthcare heart failure patients can be accelerated with improved attention to pain.” Growing evidence suggests that cannabis is an effective pain-reliever and older adults are taking notice.
Evidence for Cannabis as a Pain Reliever
A systematic review of randomized controlled trials assessing cannabis for the treatment of chronic non-cancer pain published in the Journal of Neuroimmune Pharmacology (2015), 2)Lynch, M. E., & Ware, M. A. (2015). Cannabinoids for the treatment of chronic non-cancer pain: an updated systematic review of randomized controlled trials. Journal of Neuroimmune Pharmacology, 10(2), 293-301 found that seven of the eleven trials demonstrated significant therapeutic relief. Furthermore, the most commonly reported adverse events were fatigue and dizziness.
Recent guidelines3)Allan, G. M., Ramji, J., Perry, D., Ton, J., Beahm, N. P., Crisp, N., … & Fleming, M. (2018). Simplified guideline for prescribing medical cannabinoids in primary care. Canadian Family Physician, 64(2), 111-120for Canadian family doctors outline the evidence for the prescription of medical cannabis. Based on two large evidence synopses, only three conditions have an adequate volume of evidence to inform prescribing recommendations: chronic pain, nausea & vomiting, and spasticity. However, the guidelines also recommend that physicians implement cannabinoid therapies if reasonable trials of more traditional therapies fail.
Are There Risks to Cardiovascular Health From Cannabis?
While considering that the older adult population is already at a higher risk of cardiovascular events, it is important to understand if cannabis can further exacerbate the problem. A case report in the Canadian Journal of Cardiology (2019)4)Saunders, A., & Stevenson, R. S. (2019). Marijuana Lollipop-Induced Myocardial Infarction. Canadian Journal of Cardiology, 35(2), 229-e1.details the case of a 70-year-old man who experienced a cardiac event after consuming a lollipop which contained seventy milligrams of THC. This dose of THC could be problematic for even experienced consumers. Basically, would the same man have had a cardiac event with a more controlled dose of THC? A recent review suggests not.
In a review published in Current Atherosclerosis Reports (2019), 5)Ghosh, M., & Naderi, S. (2019). Cannabis and cardiovascular disease. Current Atherosclerosis Reports, 21(6), 21. the authors found that the largest prospective study available failed to show an association between lifetime or recent cannabis consumption and cardiovascular events. Fortunately, current evidence suggests that with increased knowledge translation, practices and appropriate cannabis dosing, the risk of cardiovascular events decreases. For older adults utilizing cannabis for treating pain, the best way to consume cannabis safely is to obtain it from a knowledgeable medical professional, and follow strict medical instructions. Medical cannabis is typically available in three forms: dry flower, oils, and edibles.
Cannabis Consumption Methods for Older Adults
Generally, physicians do not recommend smoking cannabis. This is because there are harms associated with smoking, but also because there are other options available. Cannabis flower burns at about 225 degrees Celsius (440 Fahrenheit). However, the release of cannabinoids occurs at a much lower temperature, at about 160 degrees Celsius (320 Fahrenheit). A vaporizer gets hot enough to release cannabinoids without exposing the consumer to dangerous combustible compounds. However, specific dosing is more difficult. Older adults might struggle with weighing dry flower and calculating the milligrams of THC or CBD in a single dose. Thankfully, there are adaptive aids to help ageing-related issues.
Oils, oil-filled soft gels, and government-issued edibles provide more accurate doses of THC and CBD. And, they look more like traditional medicine. Additionally, there is no evidence to suggest that oils, soft gels, or any other oral cannabis consumption method poses a risk to long-term health when practicing proper dosing.
The Future of Caring for Patients With Cardiovascular Disease
Older adults are already benefiting from cannabinoid therapy. But monitoring progress and adverse events in this at-risk population are extremely important. Although promising, the research is limited. The medical community needs longitudinal randomized controlled trials. These will help to better grasp the safety and efficacy of cannabis for older adults across many conditions, including CVD.
The combination of home healthcare and cannabis treatment presents an attractive option for older adults with CVD. Considering the importance of pain reduction and the advantage of close monitoring by a healthcare professional. With more research, the future of caring for patients with cardiovascular disease could involve cannabis therapy.
References [ + ]
|1.||↑||Kang, Y., Sheng, X., Stehlik, J., & Mooney, K. (2020). Identifying Targets to Improve Heart Failure Outcomes for Patients Receiving Home Healthcare Services: The Relationship of Functional Status and Pain. Home Healthcare Now, 38(1), 24-30|
|2.||↑||Lynch, M. E., & Ware, M. A. (2015). Cannabinoids for the treatment of chronic non-cancer pain: an updated systematic review of randomized controlled trials. Journal of Neuroimmune Pharmacology, 10(2), 293-301|
|3.||↑||Allan, G. M., Ramji, J., Perry, D., Ton, J., Beahm, N. P., Crisp, N., … & Fleming, M. (2018). Simplified guideline for prescribing medical cannabinoids in primary care. Canadian Family Physician, 64(2), 111-120|
|4.||↑||Saunders, A., & Stevenson, R. S. (2019). Marijuana Lollipop-Induced Myocardial Infarction. Canadian Journal of Cardiology, 35(2), 229-e1.|
|5.||↑||Ghosh, M., & Naderi, S. (2019). Cannabis and cardiovascular disease. Current Atherosclerosis Reports, 21(6), 21.|