Background and Aims A rising number of countries allow physicians to treat chronic pain with medical cannabis. However, recreational cannabis use has been linked with cardiovascular side effects, necessitating investigations concerning the safety of prescribed medical cannabis. Methods Using nationwide Danish registers, patients with chronic pain initiating first-time treatment with medical cannabis during 2018–21 were identified and matched 1:5 to corresponding control patients on age, sex, chronic pain diagnosis, and concomitant use of other pain medication. The absolute risks of first-time arrhythmia (atrial fibrillation/flutter, conduction disorders, paroxysmal tachycardias, and ventricular arrhythmias) and acute coronary syndrome were reported comparing medical cannabis use with no use. Results Among 1.88 million patients with chronic pain (46% musculoskeletal, 11% cancer, 13% neurological, and 30% unspecified pain), 5391 patients claimed a prescription of medical cannabis [63.2% women, median age: 59 (inter-quartile range 48–70) years] and were compared with 26 941 control patients of equal sex- and age composition. Arrhythmia was observed in 42 and 107 individuals, respectively, within 180 days. Medical cannabis use was associated with an elevated risk of new-onset arrhythmia {180-day absolute risk: 0.8% [95% confidence interval (CI) 0.6%–1.1%]} compared with no use [180-day absolute risk: 0.4% (95% CI 0.3%–0.5%)]: a risk ratio of 2.07 (95% CI 1.34–2.80) and a 1-year risk ratio of 1.36 (95% CI 1.00–1.73). No significant association was found for acute coronary syndrome [180-day risk ratio: 1.20 (95% CI 0.35–2.04)]. Conclusions In patients with chronic pain, the use of prescribed medical cannabis was associated with an elevated risk of new-onset arrhythmia compared with no use—most pronounced in the 180 days following the initiation of treatment.

中文翻译：

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大麻治疗慢性疼痛：丹麦全国研究中的心血管安全性

背景和目标越来越多的国家允许医生用医用大麻治疗慢性疼痛。然而，娱乐性大麻的使用与心血管副作用有关，因此有必要对处方医用大麻的安全性进行调查。方法 使用丹麦全国登记册，识别 2018-21 年间首次使用医用大麻治疗的慢性疼痛患者，并在年龄、性别、慢性疼痛诊断以及同时使用其他止痛药物方面与相应对照患者进行 1:5 匹配。报告比较了使用医用大麻和不使用医用大麻的首次心律失常（心房颤动/扑动、传导障碍、阵发性心动过速和室性心律失常）和急性冠状动脉综合征的绝对风险。结果 在 188 万慢性疼痛患者中（46% 是肌肉骨骼疼痛，11% 是癌症疼痛，13% 是神经性疼痛，30% 是不明原因疼痛），其中 5391 名患者申请了医用大麻处方 [63.2% 为女性，中位年龄：59 岁（四分位数范围） 48-70）岁]并与 26 941 名同等性别和年龄的对照患者进行比较。180 天内，分别有 42 人和 107 人观察到心律失常。与不使用医用大麻相比，使用医用大麻会增加新发心律失常的风险{180 天绝对风险：0.8% [95% 置信区间 (CI) 0.6%–1.1%]}[180 天绝对风险：0.4] %（95% CI 0.3%–0.5%）]：风险比为 2.07（95% CI 1.34–2.80），1 年风险比为 1.36（95% CI 1.00–1.73）。未发现与急性冠脉综合征存在显着关联[180 天风险比：1.20 (95% CI 0.35–2.04)]。结论 在患有慢性疼痛的患者中，与不使用相比，使用处方医用大麻会增加新发心律失常的风险，这一点在开始治疗后 180 天内最为明显。