With medical marijuana legal in 33 states, it’s now widely viewed as a drug with the potential to treat various health conditions, from epilepsy to chronic pain. But a new study in the Journal of the American College of Cardiology suggests that those with heart conditions should use it with caution.

The study was conducted by a team of medical researchers at Brigham and Women’s Hospital and Columbia University Medical Center who performed a broad review of the cardiovascular health effects of marijuana. Their conclusion: many of the drugs used to treat heart conditions have the potential to interact with the drug. While the interaction may vary based on the drug, the root issue lies in the fact that both substances are often processed in the liver, which can interfere with how the body absorbs the medication.

Among the specific drugs listed are statins (atorvastatin, lovastatin and simvastatin), Warfarin, and nonsteroidal anti-inflammatory drugs including ibuprofen and naproxen. On top of interactions with drugs, the review found that smoking marijuana can produce “cardiotoxic chemicals” — similar to those produced from smoking cigarettes — landing it in the top three triggers for heart attack (behind cocaine and eating a heavy meal).

Muthiah Vaduganathan, MD, a cardiologist at Brigham and Women's Hospital's Heart and Vascular Center in Boston as well as the study’s lead author, says the review builds on earlier research showing a link between cannabis use and heart issues. “Our review suggests that smoking marijuana carries many of the same cardiovascular health hazards as smoking tobacco,” Vaduganathan said in a statement. “While the level of evidence is modest, there's enough data for us to advise caution in using marijuana for our highest-risk patients, including those who present with a heart attack or new arrhythmia, or who have been hospitalized with heart failure."

While smoking tobacco is generally viewed as more dangerous to heart health, Vaduganathan explains that inhaling marijuana may pose even more danger. “Smoking marijuana involves large puffs with longer breath holds,” he tells Yahoo Lifestyle. “As such, the delivery of chemical toxins and tar is deposited to a similar or greater degree with smoking marijuana.” But before vaping advocates suggest that it is a safer option, Vaduganathan says that method of delivery poses its own risks.

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“Vaping enhances the drug delivery of marijuana even beyond that of smoking,” Vaduganathan tells Yahoo Lifestyle. “Indeed, when the combustion products of both tobacco and marijuana (when smoked) are compared, both contain a similar array of toxins and substances. This information raises concerns that marijuana, when smoked or vaped, may pose similar cardiotoxic risks as tobacco smoking.”

Whether vaping, smoking or consuming marijuana, he hopes that those who read the study will walk away with the knowledge that the drug is not harmless. “Patients are increasingly inquiring about the relative safety of marijuana use; as a cardiovascular community, we need to be equipped with evidence-based responses,” he says. “As such, until further data are available, we advise caution regarding the use of marijuana in our highest risk patients with established cardiovascular disease.”

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