ISC 2021 Session: Substance Abuse in Stroke
Setareh Salehi Omran, MD
International Stroke Conference 2021
March 17–19, 2021
Session: Substance Abuse in Stroke (153, OnDemand)
The session “Substance Abuse in Stroke” at the International Stroke Conference 2021 included several presentations on the risk of stroke from a wide range of substances, including cannabis, tobacco cigarettes, e-cigarettes, alcohol, methamphetamine, and cocaine.
Marijuana and Synthetic Cannabinoid by Dr. Stephen Sidney:
Dr. Sidney discussed the potential mechanisms of cerebrovascular disease associated with cannabis use. Cannabis can lead to cerebrovascular disease through direct toxic effects on the vascular bed, altered hemodynamics (increased heart rate, increased supine blood pressure, postural hypotension), incident atrial fibrillation and atrial flutter, and endothelial dysfunction. Several studies have shown an association between cannabis exposure and increased risk of stroke. However, these studies have several major limitations, including cross-sectional study design, inability to stratify analysis by confounders (cigarette smoking, cocaine use), and lack of granular clinical information pertaining to the stroke and cannabis use (dose, composition, possible contaminants, various modes of consumption).
As it stands, it is unclear whether cannabis use is associated with stroke. It is important for clinicians to notify patients of limited data on cannabis use and stroke risk, and to advise against cannabis use in patients with known cardiovascular disease.