Caring Physician Discussing Cannabis Heart Risks

Understanding Cannabis Cardiovascular Risk: My Response to Recent Claims

Cannabis Cardiovascular Risk: Navigating the Nuances in Media and Medicine

The spotlight on “Cannabis Cardiovascular Risk” has intensified, notably with a recent CNN article by a journalist hailing from Georgia, Sandee LaMotte, sketching a picture that points to potential risks linked with marijuana use. Unfortunately, this sort of impulsive, one-sided journalism prompts an important second look at the media’s role in scientific discourse and the nuanced reality of such health risks.

The Intricacies of Cannabis and Cardiovascular Health

Cannabis and cardiovascular health share a complex relationship. The interplay of THC, the psychoactive component in cannabis, with the cardiovascular system is a subject of critical research. Studies highlight that while nitric oxide (NO) serves a protective role in vascular health, THC may impede its beneficial effects, indicating the need for a nuanced understanding of these findings. Considering the ying-yang nature of CBD and THC, this also reminds of the importance of cannabis care that is guided by experts who can help inform patients what the real risks are, and which substances may present a reality that is not only low risk, but may even pose potential benefits in cardiovascular health.

Comprehensive Perspectives Beyond THC (A narrow viewpoint)

Broadening the conversation on “Cannabis Cardiovascular Risk” requires consideration of, and the roles played by other cannabis constituents, including CBD, other minor cannabinoids, flavonoids, and terpenes. The method of cannabis consumption, from smoking or vaping to topicals, edibles, and other forms of delivery, is another important area that demands deeper discussion into their potential impacts on heart health. Ignoring the nuances of the wide range of constituents within cannabis, and demonizing it all, regardless of form, delivery, or patient, stinks worse than a skunk at a perfume factory, but perhaps not on account of the cannabis.

  • Fast aside, did you know that, when threatened, skunks spray a potent and pungent liquid from their glands as a defense mechanism? The smell is notoriously difficult to remove and can linger for a long time.  … just saying.

The Importance of Balanced Reporting in Science (Biased Science and Reporting)

The tendency of health science reporting to sensationalize findings has become increasingly common, as seen in the CNN article. However, such reports must strive to mirror the spectrum of scientific research, encompassing not just the risks but also the potential therapeutic effects of cannabis. As with any reporting and all science, wise readers should consider the scientific sources underpinning published work, as well as the qualifications and historical perspectives/biases of experts that support the reporting and sharing of views.  Do the papers themselves pose the risks about which the journalism reports?  Are the experts qualified and experienced in the domain of discussion? Have those experts shown themselves to be repeatedly bull-horning one particular viewpoint? Does the perspective appear like a solo, unending tiki-torch march against cannabis? Or, does scientific commentary present itself evenly on both sides of the discussion topic, from which the reader may derive their own conclusions?  Do you like your reporting to make your decisions for you? or do these nuances matter to YOU as the reader?  All important questions!

….If the reporting is pushing you to come to their conclusion, you should beware that, chances are, you’re not getting a full picture or the whole story.

 

Beware Causation vs Association! 

Baking Cookies (Causation): Imagine you’re baking cookies. You add sugar to the cookie dough. The sugar directly causes the cookies to taste sweet. This is causation: you do something (add sugar), and it directly causes a result (sweetness in cookies).

Roosters Crow and the Sun Rises (Association): Now, think about a rooster crowing at sunrise. The rooster crows every morning as the sun rises. However, the rooster’s crowing doesn’t cause the sun to rise. They’re associated because they happen at the same time, but one does not cause the other.

So, in causation, like adding sugar to cookies, there’s a direct cause and effect. In association, like the rooster crowing and the sunrise, two things are linked by timing or circumstance, but one doesn’t directly cause the other.

 

A Call for Rigorous Scientific Inquiry (Quality of Data)

Recognizing that each study enriches the collective understanding, it is essentially for ongoing investigations to add more rigorous evaluations. Self-reports, lackluster patient selection, a disregard of patient environmental, socioeconomic, and a patent disregard for the medical backgrounds, ongoing treatment, or personal experience with cannabis is no longer acceptable for quality, peer-reviewed study,  The half-baked attitude supporting the current research should be cause for hesitation and doubt about the nature of relevant scientific knowledge about the interplay of cannabis and cardiovascular risk. (see references below, which highlight available good quality research that draws intrinsically opposing conclusions about the effects of cannabinoid-based phenomena on cardiovascular effect. For journalist claiming to make evidence-based conclusions, or for readers expecting to derive insights about the real world, the details matter!

The Media’s Role in Scientific Discourse (limitations of the media)

Journalists have a critical role in guiding the public discourse and in shaping the direction of health and science is shaped. The importance of how information is communicated cannot be overstated. Journalists should aim to convey research findings with accuracy, ensuring complex issues are not oversimplified. For the opinions or perspectives that belong in a domain of expertise beyond the reporter, appropriate expertise, on both sides of a debate, should be included to empower readers with a balanced offering of facts  The recent CNN report underscores the influence of the media and the need for precise and comprehensive communication, and unfortunately, precisely how information can be dangerously misleading or come out so one-sided as to be outright deceitful, from a scientific point of view.

 

Why do Journalists Do This ? 

1. Overly Simple and Catchy News: Sometimes, reporters make complex science sound simpler so more people will understand it, but this can change the meaning. Headlines that say one thing causes another are more eye-catching than headlines that just show a connection, which can be misleading.

2. Getting the Science Wrong: Reporters might not always get the science right, especially if they don’t fully get the research methods or the numbers. They often use summaries or press releases that don’t give the whole story, which can lead to wrong ideas about what the research actually says.

3. Rushed Reporting and Using Secondhand Info: News moves fast, and the rush to get stories out can mean not enough time is spent checking facts, which can lead to mistakes or oversimplifications. Reporters also might rely on other articles instead of the original research, which can add to the chances of getting things wrong.

What can consumers of information do to protect themselves?

1. Seek Comprehensive Understanding: Dive deeper than headlines by reading full articles to grasp the context of scientific findings. Enhance your critical thinking by educating yourself on basic scientific principles, such as distinguishing causation from correlation. This foundational knowledge aids in evaluating the credibility of news reports.

2. Cross-Reference Information: Verify news by consulting multiple reputable sources, including the original research studies when available. Accessing abstracts and conclusions can offer more direct insights, providing a broader perspective on the subject matter and helping to identify whether certain interpretations are commonly accepted or outliers.

3. Approach with Critical Analysis: Exercise healthy skepticism and be cautious of oversimplifications in science reporting. Recognize the limitations of journalism in conveying complex scientific data, and consider using fact-checking websites to validate claims. Engage with science communicators who can effectively distill intricate concepts for wider audiences.

Considering the Breadth of Evidence

It is vital to a healthy flow of public education to acknowledge the limitations and varied results of existing studies on the potential cardiovascular risks – and potential benefits – of various cannabinoids, terpenes, and cannabis-related consumption. Journalists have a moral obligation to ensure that the public and healthcare providers receive reliable information for informed decision-making. Unless journalists are broadcasting through channels that are openly based on personal opinion, where bias and a lack of rigorous standards in research, analysis, or message broadcasting are self-evident, it is irresponsible to disseminate questionable scientific information to sway readers toward one perspective or another.

Navigating the Complex Landscape of Cannabis Research

The impact of cannabis on heart health is multifaceted, laden with complexities, and marked by many unknowns. Comprehending how cannabinoids may influence cardiovascular function—including the production, release, and degradation of Nitric Oxide, as well as determining their potential risks or benefits—is a critical area of ongoing research that is far from being fully understood

Moving the Discussion on Cannabis and Heart Health

In light of the recent media attention, it is imperative that the conversation surrounding ‘Cannabis and Cardiovascular Risk’ progresses in tandem with scientific discovery, adopting a perspective that is both open-minded and rigorously analytical. Research must delve into the complex and dynamic nature of cannabis, recognizing it as a multifactorial substance. Much like how food is not a monolith but rather a vast array of types, varieties, and flavors, each with its own nutritional profile and culinary role, cannabis too is a tapestry of diverse elements, each with distinct properties and effects

Final Reflections on Media and Medical Responsibility

Considering the potential cardiovascular risks associated with cannabis use, it is essential to foster a media environment that promotes evidence-based discussions. Simplified narratives risk obscuring the intricate reality of cannabis research and its implications for health. This underscores the shared responsibility of scientists and journalists to cultivate a dialogue that is both knowledgeable and reflective of the dynamic pursuit of scientific understanding

Simplifying Nitric Oxide’s Role in Cardiovascular Health

As a brief primer on the significance of nitric oxide (NO) in cardiovascular health: Nitric oxide is fundamental to the proper functioning of the cardiovascular system. It aids in the relaxation of blood vessels, which is essential for the regulation of blood flow. Grasping the fundamental role of NO in vascular dilation, its influence on blood pressure, and its critical role in tissue oxygenation is vital. This understanding is particularly important when considering clinical outcomes, especially in the context of heart attacks and strokes, where NO’s role becomes prominently significant.

The Connection Between Nitric Oxide and Cardiovascular Risk

The interaction between nitric oxide (NO) and cardiovascular health adds a significant layer of complexity to discussions about cannabis. NO is a critical mediator in cardiovascular physiology, influencing vasodilation and thereby impacting blood pressure and flow. It is through these mechanisms that NO can affect the likelihood of cardiovascular events such as heart attacks and strokes. For instance, reduced NO availability can lead to vasoconstriction, increased vascular resistance, and subsequent hypertension, all of which are risk factors for heart attacks. Conversely, optimal levels of NO can promote vasodilation, improve blood flow, and potentially mitigate these risks.

In practice, if cannabis were found to enhance NO production, it could theoretically support vascular health by helping maintain adequate vessel dilation and blood flow. However, should cannabis interfere with NO production or function, it might exacerbate cardiovascular risks by promoting vasoconstriction and hypertension. Understanding how cannabis compounds interact with the NO pathway is therefore essential, as it could inform both clinical practice and individual decision-making regarding cannabis use, especially for those with pre-existing cardiovascular conditions.

As we conclude the conversation on how “Cannabis Cardiovascular Risk” is represented in the media, it is clear that both journalists and medical professionals must work together to ensure that public discussions accurately reflect the complex and developing nature of scientific research. This collaboration is essential for preserving the integrity of scientific study and patient education, allowing for well-informed healthcare choices and ensuring the accuracy of the information provided to the community.

 

Listen to Dr Caplan speaking with Dr Riley Kirk, PhD about this topic, here, on her podcast

References

Papers on Nitric Oxide

2 papers that describe cannabinoid-based Nitric Oxide support and protective effects

https://drive.google.com/file/d/1nHxR5xv2bNbt0NNmEh1YsTqpFaRlMyFf/

https://drive.google.com/file/d/1MihQGU1I3yzDQNb1RgsZH37NtFhegM5l/

https://drive.google.com/file/d/1ERPC2n7U5taHYrJhhmbnlO6RlsfAutpR/

https://drive.google.com/file/d/1mCoEMyLyBUA1TBRI1LwOxZg4031vuSh2

THC as problematic, showing inhibition of NO:

https://drive.google.com/file/d/1nm_TKPyGIC3MSHuQ55EJo3-nZo0_Tfbu/

Some evidence that there is direct+indirect impact with the coupling:

https://drive.google.com/file/d/1Q3aWLbAvZVasZToTdArw7L9D7ugEa6tl/

https://drive.google.com/file/d/1W9HTapsWBr232fRhGDYNOm-ZRG3kRWOH/

Confounding of tobacco flavorings:

https://drive.google.com/file/d/1Nd44QufxCiN_EriqVgFcGFLY0k66NaKK/

https://drive.google.com/file/d/1tyXdXgeM-aJgXe4oaR3aT9z46r5dJT6d/view?usp=sharing

Terpenes also have an impact: https://drive.google.com/file/d/1tyXdXgeM-aJgXe4oaR3aT9z46r5dJT6d/

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