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Comment by arpinum | Hacker News Reader

I appreciate the study calls out that most cannabis is smoked, and it may be general smoke inhalation driving these results rather than an inherent property of cannabis

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I too wonder if it is due to the way it was consumed primarily (smoking).

There is a bit about the impact of cannabinoids on the cardiovascular system however.

> The impact of exogenous cannabinoids on the cardiovascular system has been well described.7,33 After acute exposure, cannabis induces dose-dependent tachycardia and, in some cases, decreased ventricular contractility, palpitations, atrial fibrillation and arrhythmia.

Table 2 differentiates the form of consumption but I couldn't find them controlling for it. Did I miss that somehow?

In the "Interpretation" section of the paper they specify: "Although a similarly elevated odds of history of heart attacks was observed across methods of recent cannabis consumption, only smoking as a primary method achieved statistical significance."

>After acute exposure, cannabis induces dose-dependent tachycardia and, in some cases, decreased ventricular contractility, palpitations, atrial fibrillation and arrhythmia

i feel like this is saying what a lot of us already know about cannabis usage, more specifically about THC as this won't be found as much in low THC strains: higher doses have a tendency to cause anxiety sometimes. all of those symptoms tend to be, at least in my experience, pretty comorbid with a state of high anxiety, and more often than not, I would think, the more easily observable ones than the neurological or psychological effects associated therewith.

It very likely is due to smoke inhalation or even mixing with tobacco; IIRC inhalation of any kind of micro- and nanoparticles is linked to higher risk of myocardial infarction.

I got a few new sativa vapes recently and was hitting them both pretty hard. I got smacked with a really disturbing heart issue that felt like it was being severely over worked. It was so bad I was on my front porch in n the dark resolved to dying. I didn't in now what was going to happen.

I'll admit that I'm a lightweight but I had to stop with the "turpine pens." Now I just smoke dry herb because I know how to regulate it and it never presented any issues like I experienced.

In the run up to that I did experience heart issues (racing/skipping?) but it was no where near that episode. I have noticed that sugar greatly exasperates the heart issues for me.

Sativa can give people anxiety and it can feel like a heart issue.

Pens make it easier to get a bigger hit than a normal joint dose, so take smaller puffs.

I think it is completely dependent on the person. Some people get anxiety from the bodily effects of indicas while some people seek out those muscle-relaxing, stress-clearing ”stoned” effects.

Some people get anxiety from the high-flying thoughts brought about by sativas and some people seek out those idea-provoking cerebral ”high” effects.

Of course I can't rule out that you actually had a cardiovascular problem, but of the people who get really high and think they have a medical problem, it's usually an anxiety attack.

Everyone likes to say that but as a cannabis user for 20+ years, most cannabis does raise HR when it "hits." It also can cause anxiety. Those two things combined can make HR even higher through a feedback loop. But it's disingenuous to think it doesn't raise HR in higher doses - that it's just an anxiety issue. Indica or sativa, they both cause a HR increase during intake. In my experience, it can taper off and one still remains high. But other times, the effect can last a while and the anxiety can turn into a full blown panic attack.

Imagine the scenario where someone legitimately has a HR of 150 from Cannabis. They have anxiety about their heart rate and possibly dying, and their friend OP keeps insisting that they just need to "calm down and be cool" because this is "all in your head." That's what ignorant friends are for :-)

"One of the most consistent effects of cannabis smoking on heart is 20% to 100% increase in HR which can last up to 2–3 hours, often accompanied by a slight increase in supine blood pressure. This effect of cannabis on HR is thought to be due to cannabis induced vasodilation causing reflex tachycardia (15,16)."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542986/

>They have anxiety about their heart rate and possibly dying, and their friend OP keeps insisting that they just need to "calm down and be cool" because this is "all in your head." That's what ignorant friends are for :-)

999 times of a thousand (likely much more) this is the correct response. As you acknowledged there's a feedback loop and external reasons to justify it are likely to increase your HR even further. Given that it increases anxiety and paranoia the times when people have a real problem are going to be extrme rarer compared to the amount of times they are just causing themselves extra anxiety by freaking out.

Also 150 is still not really an issue. Anxiety can cause that and it can safely drop after calming down.

There's really nothing wrong with going to the hospital to get checked up if you've taken something that might be killing you. 150 is pretty high for a body that isn't exercising. If I had insurance and my HR was that high from a substance, and wasn't falling, I'd be on my way to the hospital if the diazepam I keep on hand didn't help. Your risk assessment is different. Trying to give stats on something neither of us can reliably give, is very silly.

I'd recommend looking into vaping dry herb with a Volcano to avoid the combustion of organics as well as the chemicals on the pens.

Sounds like an anxiety or panic attack. The latter often sends people to the ER because they think they're dying.

I know of at least one company that was founded to provide cigar enthusiasts a way to get access to tobacco to roll their own cigars at home, because the industry usually requires you to purchase the product by the bale. Because of the fragility of wrapper tobacco, they would place these in humidified sealed pouches.

They soon learned that there was a large market for this and now they make 99% of their revenue selling wrappers in convenience stores. The cigar tobacco shop is still there, because it was mostly a labor of love instead of a true business venture.

So what used to be paper wrappers is now replaced with a more premium product, but that premium product happens to be black tobacco which is much harsher than the cigarette tobacco people inhale regularly.

> Smoking cannabis was the most prevalent primary method of consumption (76.3%, 95% CI 74.3%–78.4%) relative to vapourization (11.3%, 95% CI 9.8%–12.8%) and other forms of consumption, including edibles (12.4%, 95% CI 10.8%–13.9%).

> Compared with nonusers, the prevalence of recent cannabis use was higher among males (62.9% v. 49.3%), unmarried respondents (68.0% v. 46.4%), current combustible cigarette users (31.6% v. 13.2%), current e-cigarette users (18.1% v. 5.1%) and heavy alcohol drinkers (17.4% v. 5.2%).

You run into cannabis users that have massively high tolerances because they dab all day. I wonder how d8, d10, etc would come out, cause that's probably a big part of the future, that an other cannaboid mixes.

This study is really just "smoking linked to higher risk".

I think it's any marijuana use, not just smoking:

The primary exposure for our study was any recent cannabis use, categorized as a binary outcome. In the BRFSS, participants were asked, “During the past 30 days, on how many days did you use [marijuana or hashish (2017)] [marijuana or cannabis (2018)]?” We defined any recent cannabis use as using cannabis 1 or more time during the past 30 days.

Results for other methods of consumption were not statistically significant:

"Similarly, a higher odds of history of MI was observed with vapourization as a primary method of cannabis consumption (adjusted OR 2.26, 95% CI 0.58–8.82) and other forms of cannabis consumption, including edibles (adjusted OR 2.36, 95% CI 0.81–6.88) when compared with nonusers; however, these were not statistically significant."

When they say "primary method of cannabis consumption" do they mean the primary method of consumption in the past 30 days? Or do they mean the primary method of lifetime consumption?

I'm also not sure "primary method of consumption" is the right question to ask? If someone smokes three days a week and has edibles the other four their primary method would be edibles but that doesn't erase the risk of the smoking.

CDC has archival surveys at https://www.cdc.gov/brfss/questionnaires/index.htm

The phrasing based on 2018 form was:

"During the past 30 days, which one of the following ways did you use marijuana the most often? Did you usually…"

Smoking a joint is every bit as bad as smoking a cigarette, in terms of carcinogens/tar and other nastiness, but most people aren't two-pack-a-day joint smokers so dose is typically lower. It still isn't healthy though.

IIRC smoking a joint is actually worse than smoking a cigarette, one-for-one, because of the filter a cig has. Smoking joints, the activity, is still said to be healthier than smoking cigarettes, because of the disparity in cylinders-consumed-per-day in average users, as the parent points out. That said, outliers, like Sublime's frontman Bradley Nowell, do exist. [0] Humour on HN is a risky business, but what I'm trying to imply is that I've known people who would find it quite reasonable to smoke two joints before they smoked two joints, and then they'd smoke two more. That's worse than a cigarette habit. Vapes, on the other hand...

[0] https://www.youtube.com/watch?v=h0i62GnQoo0

It doesn't say that at all.

>The effect estimates for history of MI were similar across methods of consumption, including among people using other forms of cannabis, including edibles, as a primary method of consumption. This finding is consistent with a case study reporting an acute MI triggered after consumption of a lollipop containing a large dose of Δ-9-tetrahydrocannabinol.36 The Canadian government recently legalized cannabis edibles;2 however, the risks associated with edibles are poorly understood and are of concern to Canadian physicians.37 Edibles are often perceived as a safer alternative for cannabis consumption, but recent evidence suggests that edible cannabis is attributed to a larger proportion of cannabis-related emergency department visits for cardiovascular symptoms compared with inhaled cannabis

“Although a similarly elevated odds of history of MI was observed across methods of recent cannabis consumption, only smoking as a primary method achieved statistical significance.“

That is honestly a pretty confusing sentence in need of clarification. My read would be that statistical significance was not achieved due to the small sample size of users who are primarily using other methods of consumption than smoking.

If there isn't statistical significance there isn't statistical significance. It does not matter what caused the lack of it. Without statistical significance there is "no evidence".

Not likely- the odds ratio vs non-users for smoking (2.01) is lower than that for vaping (2.26) and "other" (2.36).

They say that this is not statistically significant, however all forms of cannabis use vs non-users is statistically significant, with an odds ratio of 2.07 overall, and 2.31 for frequent users.

So if anything, the data suggests the opposite: smoking was lowest odds ratio.

Also, they adjust the findings to account for users that smoke, vape, etc, so it's not due to the fact that users are also more likely to smoke (compared to non-users).

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