Getting Heart Smart with Cannabis

By Dr. Rachel Knox, MD, MBA, MCBA Medical Chair

At The Heart of Disparity: the hard truth

Each February we celebrate Black History and Heart Health month in the United States. These two themes may initially strike you as unrelated, but the irony of their juxtaposition is actually profound. Heart disease is the leading cause of death in the US for all people, however people of color — namely American Blacks — are 41% more likely to develop high blood pressure than American Whites, 2.1 times as likely to die from complications of high blood pressure, and 1.3 times as likely to die from heart disease. Moreover, these rates haven’t changed in two decades. The heart disease disparity is a stain on the fabric of black health history, and these statistics are ever more frustrating given that these cardiovascular conditions are preventable and naturally reversible with diet and lifestyle changes. Concerning still is the staggering difference in the care the Black and White populations receive for the same disease, especially in regards to preventive resources, access to care, utilization of available care, and equal quality of care.

Despite national interest in closing health inequity gaps between racial groups, Black Americans remain poorly represented in clinical trials, including lifestyle, intervention, and drug studies. And despite ongoing prescription drug development and advancing technologies in cardiovascular intervention, the clinical management of Black Americans is not achieving improved outcomes. Health inequity is a chronic problem, and our conventional care system is likely not going to provide a solution — it hasn’t yet. With decades of cannabis research showing potential in treating and reversing ischemic heart disease and lowering blood pressure, the evidence may indicate that it’s time for Black Americans to consider something else: cannabis.

The Closing of an Era of Uncertainty: an evidence-based review

As states legalize cannabis use, an increasing number of people are incorporating it into their lives and daily routines for the purpose of improved health. However, with increased access and use comes a significant amount of fear and uncertainty about cannabis’ potential negative effects. There have been promising discoveries about the heart healthy potential of cannabis, but there are some caveats worth noting.

Let’s first discuss the pros that we know. Several cannabis studies suggest that cannabis is useful in treating hypertension, and in the acute on setting of heart attack. In 2014, Circulation, a popular medical journal sponsored by the American Heart Association, published a study authored by NIH researchers concluding that cannabis can normalize blood pressure by mechanisms that resulted in dilating blood vessels and relaxing the heart. This finding was corroborated by another study performed at the University of Nottingham the same year concluding that cannabis presents a natural way to lower blood pressure and improve circulation. Prior to this, in 2010, the British Journal of Pharmacology demonstrated the cardioprotective nature of CBD in the on setting of a sudden heart attack by both reducing abnormal heart rhythms and lessening the size of the injured areas of heart tissue.

Whole plant cannabis also provides additional antiinflammatory and antioxidative properties that further contribute to heart disease prevention and overall cardiovascular health (including the prevention or reversal of atherosclerosis — the narrowing of blood vessels due to blockage — a condition conventionally thought to be caused by high cholesterol). At its root, heart disease is a disease of inflammation. Whole plant cannabis — just like fruits, vegetables and other botanicals — contains a variety of beneficial nutrients in addition to its phytocannabinoids (i.e. THC or CBD) that reduce inflammation in the entire body.

Additional studies are well underway to further flesh out the specific mechanisms of action that lead to the observed cardiovascular benefits of cannabis, and we should anticipate human clinical trials to follow. It is encouraging.

Using cannabis for heart health, or any medical condition, requires informed and intentional implementation. This is because cannabis use is not without risks. Chiefly, cannabis contains a molecule — a psychoactive phytocannabinoid called THC — that can cause anxiety and rapid heart rates at high concentrations. What complicates this matter is that “high concentrations” of THC is relative, as THC can affect a naive and seasoned cannabis user differently at the same concentration. This is important to understand, especially in the context of heart disease, for a couple of reasons. The symptoms of severe anxiety and panic attacks are similar to those of myocardial infarctions or heart attacks. Additionally, a rapid heart beat brought on by an over-dose of THC could potentially trigger an abnormal heart rhythm or lead to coronary blood vessel constriction in at risk patients, and such adverse events could culminate in decreased blood flow to the heart causing heart attack. This can be mitigated by using low THC cannabis strains or increasing the amount of THC in a given cannabis preparation slowly, starting at a low dose, and capping its concentration at the lowest, most effective (and tolerated) dose for treating a specific condition. It is also highly encouraged that patients consult with a cannabis or cannabinoid specialist who can assist them in navigating the use of their cannabis therapy.

A Proposal for a New Narrative: a simple consideration

Black Americans have an opportunity to overwrite the narrative of Black health history in the US. In a healthcare system with disparate health outcomes negatively impacting Black Americans, it is high time (no pun intended) that Black Americans consider alternatives to the conventional way. Dietary and lifestyle changes remain paramount. Maintaining a natural, unprocessed whole food diet, like a Paleo or Vegan diet, is a proven method of reversing heart disease. Making dietary and lifestyle changes does not require a prescription pad, only the decision to eat or act differently. To consider cannabis for the aforementioned benefits is an additional alternative.

Would you consider it? I argue that we must. Considering cannabis leads to understanding cannabis. Understanding cannabis leads to advocating for its use in our communities. Advocating for cannabis use leads to legislative reformation. Legislating reformation leads to legal and accessible cannabis for study and as medicine for all.

Dr. Rachel Knox, MD, MBA

Co-founder of The Canna MDs and The American Cannabinoid Clinics

Medical Chair, The Minority Cannabis Business Association

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