Prevalence, trends and in-hospital outcomes of takotsubo syndrome among United States cannabis users

Rupak Desai, Aakash Desai, Hee Kong Fong, Ahmed Mahmood, Kaushal Shah, Vaishnavi Reddy Varakantam, Fariah Asha Haque, Sejal Savani, Kishorbhai Gangani, Gautam Kumar, Rajesh Sachdeva
International Journal of Cardiology 2020 June 5

BACKGROUND: Recent reports suggest a link between increased cannabis (marijuana) use and stress-cardiomyopathy (Takotsubo Syndrome, TTS) and related complications. Amidst recent trends in cannabis legalization and a paucity of data, it remains essential to evaluate the prevalence, trends and outcomes of TTS in cannabis users on a large-scale.

METHOD: We studied prevalence and trends in TTS among adult cannabis users vs. non-users using the National Inpatient Sample (2007-2014). Baseline characteristics, comorbidities, and in-hospital outcomes of TTS were compared between cannabis users vs. non-users. Weighted logistic regression was performed adjusting for confounders to estimate the inpatient outcomes of TTS with vs. without cannabis use.

RESULTS: The overall prevalence of TTS in cannabis users (47/100,000) was lower as compared to non-users (62/100,000). Rising trends in TTS among cannabis users (<11 to 82, ~8-fold) were more pronounced as compared to non-users (19 to 108, ~6 fold) per 100,000 hospitalizations from 2007 to 2014 (ptrend  < 0.001). Of all inpatient encounters for TTS (n = 156,506), 1565 (0.1%) reported cannabis use. Polysubstance use including alcohol (4.1% vs. 24.4%), cocaine (0.4% vs. 8.5%), amphetamine (0.2% vs. 8.0%), and smoking (31.2% vs. 64.8%) was significantly higher in TTS-cannabis cohort. Although cardiovascular comorbidities were lower in TTS-cannabis cohort, the adjusted odds of all-cause mortality (aOR1.50, p < .05) were 50% higher in cannabis users compared to non-users without statistically significant difference in cardiac complications.

CONCLUSIONS: Cannabis users showed lower prevalence but a more pronounced rising trend of TTS and subsequent risk of in-hospital mortality compared to non-users.

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