Well-designed clinical trials to test the safety and efficacy of cannabidiol (CBD) for cardiovascular disease are needed, based on evidence from preclinical studies showing that it has anti-inflammatory effects, a new report suggests.
The systematic review of nine preclinical studies found reproducible positive cardiovascular outcomes in in vivo models with CBD. Mechanisms for the findings included reduction in oxidative stress and inflammation.
“CBD worked very well in all the experimental models, compared to placebo,” lead author Mario Zúñiga, MD, a cardiology fellow at Hospital Regional 1º de Octubre Issste in Mexico City, Mexico, told theheart.org | Medscape Cardiology.
“It seems CBD has true potential in the setting of myocardial infarction, reperfusion, arrhythmias and metabolic syndrome-like conditions,” Zúñiga said.
He presented his study in a poster session at ACC Latin America 2022 Together With CardioAcademic, which was held in Mexico City.
“Cannabidiol and medical cannabis use, alongside its many products, has increased considerably in the last decade, but there are few indications for its use based on good clinical trials,” he said.
“Here, we sought to provide preclinical evidence, which ultimately serves as the cornerstone to establishing well-designed clinical trials in humans, to prove the effect on CBD on coronary syndromes with strong scientific evidence,” Zúñiga said.
CBD has substantial evidence for pain, cachexia, nausea and vomiting, multiple sclerosis spasticity, and most recently, epilepsy, he added. “Its pharmacological profile shows it is safe and well-tolerated in humans, although it has well described side effects. But the interaction with other medications often used by cardiologists, such as anticoagulation and antiplatelet drugs, is not well-known.”
He and his team did their systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) and Collaborative Approach to Meta Analysis and Review of Animal Data from Experimental Studies (CAMARADES) guidelines; in the electronic database from PubMed, Web of Science, and Scopus; up to April 2022.
The nine preclinical studies in their review, which were done in rats and rabbits, showed that CBD reduced infarct size when it was administered before the ischemia in four of the studies.
In addition, interleukin 6, cardiac troponin I levels, ventricular arrhythmias, oxidative stress, myocardial fibrosis, and heart mass were also reduced after administration of CBD.
“We think that CBD will eventually be part of the treatment of coronary syndromes in the not-so-distant future, and that it is time to study its potential in proper randomized trials,” Zúñiga said.
A “Big Leap”
Robert L. Page, III, PharmD, chair of the writing group for the American Heart Association’s (AHA’s) 2020 Cannabis Statement and professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, commented on this study for theheart.org | Medscape Medical News.
“The bulk of the data that are out there, particularly in the evaluation of clinical benefits, are primarily in animal data, and I have a big problem making that leap. The AHA’s clinical science statement, which was published in 2020 basically said that there’s really no evidence at this point to support any cardiovascular benefit,” Page said.
Removing the Schedule I status of cannabis, as proposed by the MORE Act, just passed in the US House of Representatives in April 2022, will make doing phase 1 studies possible, he said.
“The MORE Act has now gone to the Senate. So, until we can actually remove the Schedule I status and let it be evaluated in a good phase 1 clinical trial, in healthy humans, I warn against indiscriminate use, particularly in patients with acute coronary syndromes because of the potential proarrhythmic effects of any cannabis product,” Page said.
Zúñiga and Page report no relevant financial relationships.
ACC Latin America 2022 Together With CardiAcademic. Presented September 10, 2022. Abstract #130