A systematic review and meta-analysis of randomized controlled trials of cardiovascular toxicity of medical cannabinoids

Published:March 26, 2021DOI:



      Several systematic reviews (SRs) have summarized the potential effectiveness of medical cannabinoids, but it is unclear to what extent safety-related outcomes were incorporated.


      The objective of this study was to evaluate the cardiovascular toxicity associated with medical use of cannabinoids.


      A 2-stage systematic review (SR) approach was undertaken to assess the current evidence on cannabinoid-associated cardiovascular events reported among randomized controlled trials (RCTs). First, we searched for SRs in multiple sources until June 2019. Second, RCTs identified from the SRs were included if they assessed medical cannabis and reported cardiovascular events. The outcomes of interest were all types of cardiovascular events. Data were extracted by 2 independent reviewers. Study quality was assessed using the Cochrane risk of bias. A statistical test of heterogeneity was performed. The summary risk ratios (RRs) and 95% CIs were calculated using a random-effects model.


      A total of 47 studies involving 2800 patients were included. The median duration of cannabinoid use was 15.8 days (range 1 to 322), and 45% of the studies excluded patients with underlying cardiovascular diseases. Cannabinoid use was significantly associated with increased risks of orthostatic hypotension (RR 3.16 [95% CI 2.27–4.40], I2 = 2.3%) and hypotension (3.55 [1.45–8.71], I2 = 31.8%), with a trend of increased risk of tachycardia (1.94 [0.81–4.64], I2 = 48.6%). No study reported serious cardiovascular events.


      Cannabinoid use was associated with tachycardia, hypotension, and orthostatic hypotension. There is a paucity of data for other cardiovascular events among medical cannabis users. More data, especially regarding long-term effects among patients with existing cardiovascular diseases, are needed.
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      Alexandre H. Watanabe, PharmD, Postdoctoral Fellow, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT


      Leenhapong Navaravong, MD, Assistant Professor, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT


      Thitipong Sirilak, PharmD, Pharmacist, Department of Pharmacy, Wiang Haeng Hospital, Chiang Mai, Thailand


      Ratthanon Prasitwarachot, MS, Instructor, Department of Pharmacy Technicians, Sirindhorn College of Public Health, Suphanburi, Thailand


      Surakit Nathisuwan, PharmD, BCPS, Associate Professor, Department of Pharmacy, Mahidol University, Bangkok, Thailand


      Robert L. Page II, PharmD, MSPH, BCPS, Professor, Department of Clinical Pharmacy, University of Colorado, Aurora, CO


      Nathorn Chaiyakunapruk, PharmD, PhD, Professor, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT