News in brief: Cannabis use linked to MI in young people; Room to improve management of FH; Global medical journals call for emergency action on climate crisis

Cannabis use linked to MI in young people

Cannabis use could increase myocardial infarction (MI) risk in young adults, according to US researchers.

Their study of 33,173 adults aged 18–44 years showed people who had used cannabis in the last 30 days were more likely to have a history of MI (61 of 4,610, 1.3%) than non users (240 of 28 563, 0.8%, adjusted odds ratio [OR]: 2.07, 95% CI 1.12–3.82).

A history of MI was also associated with frequent cannabis use (more than four times per month, adjusted OR: 2.31, 95% CI 1.18–4.50) and smoking as the primary method of consumption (adjusted OR 2.01, 95% CI 1.02–3.98), the authors wrote in the Canadian Medical Association Journal.

The researchers said there were several possible mechanisms linking cannabis and cardiovascular disease, notably that cannabis induces dose-dependent tachycardia and decreased ventricular contractility, palpitations, atrial fibrillation and arrhythmia.

Activation of the cannabinoid receptor subtype 1 has also been shown to increase myocardial oxygen demand, induce platelet activation and cause endothelial dysfunction, they noted.

“Our study provides evidence supporting an association between recent cannabis use and history of MI in young adults. Increasing cannabis use in an at-risk population could have negative implications for cardiovascular health,” they concluded.

Room to improve management of FH

Heterozygous familial hypercholesterolaemia (FH) is diagnosed too late – at a median of 44.4 years.

Data from more than 42,000 adults in the Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry showed only 40% of patients were under 40 years at the time of their diagnosis.

The study also showed only a minority of people (21.2%) were being managed with combination therapy despite the fact that guideline-recommended LDL cholesterol concentrations were infrequently achieved with single-drug therapy.

The study found combination therapy, particularly with three drugs and with PCSK9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L.

Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men.

Read more – the paper and an editorial – in The Lancet

Global medical journals call for emergency action on climate crisis

More than 230 international medical journals are standing together to demand urgent action on climate change, in a bid to prevent further catastrophic harm to health.

In an unprecedented move, the journals have simultaneously published a joint editorial calling on governments to halt the destruction of nature, protect health, and create “a sustainable, fairer, resilient, and healthier world,” ahead of this month’s UN General Assembly climate conference in Glasgow, UK.

The editorial, published in titles such as The BMJ, The Lancet, NEJM, The European Heart Journal, Cardiovascular Research, and The MJA, warns that the greatest threat to global public health is the failure of world leaders to take sustained and effective action to rein in global temperature rises.

Recent targets to reduce emissions and conserve nature are welcome but do not go far enough, and “are yet to be matched with credible short and longer term plans to accelerate cleaner technologies and transform societies”, it said.

Insufficient action means that temperature rises “well in excess” of 2°C are now likely, which would represent a “catastrophic outcome for health and environmental stability”.

Addressing the climate threat will require a similar level of funding as that made available by the government in the fight against COVID-19, the authors said.

“Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such investments will produce huge positive health and economic outcomes.”

Dr Fiona Godlee, Editor-in-Chief of The BMJ, and one of the co-authors of the editorial, said healthcare professionals who have been on the frontline of the COVID-19 crisis “are united in warning that going above 1.5C and allowing the continued destruction of nature will bring the next, far deadlier crisis”. “2021 has to be the year the world changes course – our health depends on it.”

The editorial was coordinated by the UK Health Alliance on Climate Change.

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