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Evaluation of the cardiovascular risk induced by cannabis use from a series of 43 autopsy cases

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Abstract

The aim of this monocentric observational autopsy study was to confirm the existence of a link between cannabis use and cardiovascular risk. It was based on the analysis of autopsy findings, cardiovascular pathological findings, and toxicological data in 43 autopsy cases of people who died with tetrahydrocannabinol (THC) in their blood over a 2-year period. Hair analysis was performed when available (n = 40) to distinguish between occasional and chronic cannabis use and to take into account other possible exposures, including smoking, drug consumption, and the use of other drugs of abuse (mainly cocaine, heroin, and amphetamine). A statistically significant association (Fisher’s exact test, p < 0.001) was found between cannabis use, an undetermined manner of death, and the presence of an arrhythmogenic cardiac condition. An association was also found between cannabis use and the presence of advanced coronary heart disease (p = 0.01), heart disease (including ischemic heart disease, p = 0.003), or cardiomyopathy (p = 0.01). Through its systemic vascular action, cannabis could be a factor in triggering sudden death in subjects with arrhythmogenic cardiac conditions. In view of this finding, the mode of death of subjects who died in the presence of THC in the blood would in most cases be an “accident.” These results highlight the potential adverse cardiac effects associated with cannabis use.

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Authors and Affiliations

  1. Service de Médecine légale, Groupe Hospitalier Universitaires AP-HP.Paris-Saclay, hôpital Raymond Poincaré, 104 bvd R. Poincaré, 92380, Garches, France

    Paul Cotier & Geoffroy Lorin de la Grandmaison

  2. Service de Pharmacologie-Toxicologie, Hôpital Raymond Poincaré, Groupe Hospitalier Universitaires AP-HP.Paris-Saclay, 92380, Garches, France

    Charlotte Mayer, Isabelle Etting & Jean-Claude Alvarez

  3. Université Paris-Saclay/Versailles, Inserm U-1018, CESP, Équipe MOODS, Plateforme de spectrométrie de masse, 78180, Montigny-le-Bretonneux, France

    Jean-Claude Alvarez

  4. Laboratoire de Pharmacologie – Toxicologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, 104, Boulevard R. Poincaré, 92380, Garches, France

    Jean-Claude Alvarez

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  1. Paul Cotier
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  2. Charlotte Mayer
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  3. Isabelle Etting
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  4. Geoffroy Lorin de la Grandmaison
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  5. Jean-Claude Alvarez
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Contributions

The study was designed and coordinated by PC and JCA. PC and JCA drafted the manuscript. GLM recruited patients and was responsible of the anatomopathological results. CM was responsible of the toxicological results. PC collected all data in the study. IET conducted all the quantifications in blood and hair. All authors contributed to interpretation of the data, critically revised the manuscript, and approved the final version.

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Correspondence to Jean-Claude Alvarez.

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Cotier, P., Mayer, C., Etting, I. et al. Evaluation of the cardiovascular risk induced by cannabis use from a series of 43 autopsy cases. Int J Legal Med 137, 1725–1733 (2023). https://doi.org/10.1007/s00414-023-03079-x

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