Abstract
Cannabis and its compound constituents are being used globally for medicinal and recreational purposes. There has been a growing interest in the use of cannabis, specifically cannabidiol (CBD), and its potential effects on vascular health measures. However, no study has investigated the use of CBD vascular health measures via flow-mediated dilation (FMD) ultrasound assessment. This review aims to critically evaluate emerging evidence of the influence of CBD on vascular health via FMD ultrasound assessment in exercising populations. Examining associations among CBD use, vascular health, and exercise may enhance understanding of how cannabis constituents affect cardiovascular response during exercise. Illuminating the cardiovascular effects of CBD on exercising populations is vital for researchers and sports practitioners, given the global use of this cannabinoid and its potential to interact with exercisers’ vascular health and exercise performance. While few examinations of CBD and FMD have shown effects on performance and vascular health, studies of adequate rigor to demonstrate cannabinoid effects on FMD require future research.
References
Babson KA, Sottile J, Morabito D. Cannabis, cannabinoids, and sleep: A review of the literature. Curr Psychiatry Rep. 2017;19(23):1-12.
Birk GK, Dawson EA, Batterham AM, Atkinson G, Cable T, Thijssen DHJ, Green DJ. Effects of exercise intensity on flow mediated dilation in healthy humans. Int J Sports Med. 2013;34(5):409-414.
Blair SN, Morris JN. Healthy hearts – and the universal benefits of being physically active: Physical activity and health. Ann Epidemiol. 2009;19:253-256.
Bright TP, Farber MO, Brown DJ, Forney RB. Cardiopulmonary effects of cannabidiol in anesthetized dogs. Toxicology and Applied Pharmacology. 1973;31:520-526.
Burr JF, Cheung CP, Kasper AM, Gillhan SH, Close GL. Cannabis and athletic performance. Sports Med. 2021;51(Suppl 1):S75-S87. https://doi.org/10.1007/s40279-021-01505-x
Celermajer DS, Sorensen K, Gooch V. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis The Lancet. 1992;340(8828):1111-1115.
Cheung CP, Coates AM, Millar PJ, Burr JF. Habitual cannabis use is associated with altered cardiac mechanics and arterial stiffness, but not endothelial function in young healthy smokers. J Appl Physiol. 2021 Mar 1;130(3):660-670. doi: 10.1152/japplphysiol.00840.2020. Epub 2021 Jan 14. PMID: 33444123.
Clarkson P, Montgomery HE, Mullen MJ, et al. Exercise training enhances endothelial function in young men. J Am Coll Cardiol. 1999;33(5):1379-1385.
Cochrane-Snyman K, Cruz C, Morales J, Coles M. The effects of cannabidiol oil on noninvasive measures of muscle damage in men. Med Sci Sports Exerc. 2021;53(7):1460-1472.
Cooper LL, Palmisano JN, Benjamin EJ, et al. Microvascular function contributes to the relation between aortic stiffness and cardiovascular events: The Framingham heart study. Circ Cardiovasc Imaging. 2016;9(12):e004979.
Crocq MA. History of cannabis and the endocannabinoid system. Dialogues Clin Neurosci. 2020 Sep;22(3):223-228. doi: 10.31887/DCNS.2020.22.3/mcrocq. PMID: 33162765; PMCID: PMC7605027.
Crossland BW, Rigby BR, Duplanty AA, et al. Acute supplementation with cannabidiol does not attenuate inflammation or improve measures of performance following strenuous exercise. Healthcare. 2022;10(6), 1133.
Deanfield JE, Halcox JP, Rabelink TJ. Endothelial Function and Dysfunction. Circulation. 2007;115(10):1285-1295.
Di Francescomarino S, Sciartilli A, Di Valerio V, Di Baldassarre A, Gallina S. The effect of physical exercise on endothelial function. Sports Med. 2009;39(10):797-812. doi:10.2165/11317750-000000000-00000
Docter S, Khan M, Gohal C, Ravi B, Bhandari M, Gandhi R, Leroux T. Cannabis Use and Sport: A Systematic Review. Sports Health. 2020 Mar/Apr;12(2):189-199. doi: 10.1177/1941738120901670. Epub 2020 Feb 5. PMID: 32023171; PMCID: PMC7040945.
Durst R, Danenberg H, Gallily R, Mechoulam R, Meir K, Grad E, Beeri R, Pugatsch T, Tarsish E, Lotan C. Cannabidiol, a nonpsychoactive cannabis constituent, protects against myocardial ischemic reperfusion injury. Am J Physiol Heart Circ Physiol. 2007 Dec;293(6):H3602-7. doi: 10.1152/ajpheart.00098.2007. Epub 2007 Sep 21. PMID: 17890433.
Goto C, Higashi Y, Kimura M, et al. Effect of different intensities of exercise on endothelium-dependent vasodilation in humans: Role of endothelium-dependent nitric oxide and oxidative stress. Circulation. 2003;108:530-535.
Hatchett A, Armstrong K, Hughes B, Parr B. The influence cannabidiol on delayed onset of muscle soreness. International Journal of Physical Education, Sports and Health. 2020;7(2):89-94.
Hurd YL. Leading the next CBD wave - Safety and efficacy. JAMA Psychiatry. 2020;77(4):341-342.
Inoue T, Matsuoka H, Higashi Y, et al. Flow-mediated vasodilation as a diagnostic modality for vascular failure. Hypertens Res. 2008;31(12):2105-2113.
Jones H, Green DJ, George K, Atkinson G. Intermittent exercise abolishes the diurnal variation in endothelial-dependent flow-mediated dilation in humans. Am J Physiol. 2010;298:R427-R432.
Kicman A, Toczek M. The effects of cannabidiol, a non-intoxicating compound of cannabis, on the cardiovascular system in health and disease. Int J Mol Sci. 2020 Sep 14;21(18):6740.
Kvålseth TO. Effects of marijuana on human reaction time and motor control. Perceptual Motor Skills.1977;45(3), 935-939.
Lisano JK, Phillips KT, Smith JD, Barnes MJ, Stewart LK. Patterns and perceptions of cannabis use with physical activity. Cannabis. 2019;2(2), 151-164.
Lucas CJ, Galettis P, Schneider J. The pharmacokinetics and the pharmacodynamics of cannabinoids. Br J Clin Pharmacol. 2018;84(11):2477-2482. doi:10.1111/bcp.13710
Matsuzawa Y, Kwon TG, Lennon RJ, et al (2015) A prognostic value of flow-mediated vasodilation in brachial artery and fingertip artery for cardiovascular events: A systematic review and meta-analysis. J Am Heart Assoc 4(11).
Maurer GE, Matthews NM, Schleich KT. Understanding cannabis-based therapeutics in sports medicine. American Orthopedic Society for Sports Medicine. 2020;12(6):540-546.
McCartney D, Benson MJ, Desbrow B, Irwin C, Suraev A, McGregor IS. Cannabidiol and sports performance: A narrative review of relevant evidence and recommendations for future research. Sports Med Open. 2020 Jul 6;6(1):27. doi: 10.1186/s40798-020-00251-0. PMID: 32632671; PMCID: PMC7338332.
Moholdt TT, Amundsen BH, Rustad LA, et al. Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: A randomized study of cardiovascular effects and quality of life. American Heart Journal. 2009;158:1031-1037.
Muiesan ML, Salvetti M, Monteduro C, et al. Effect of treatment on flow-dependent vasodilation of the brachial artery in essential hypertension. Hypertension. 1999;33(1 Pt 2):575-580. doi:10.1161/01.hyp.33.1.575
Nagarkatti P, Pandey R, Rieder SA, Hegde VL, Nagarkatti M. Cannabinoids as novel anti-inflammatory drugs. Future Medicinal Chemistry. 2009;1(7):1333–1349. https://doi.org/10.4155/fmc.09.93
Niesink RJ, van Laar MW. Does cannabidiol protect against adverse psychological effects of THC? Front Psychiatry. 2013;4:130.
Noreen N, Muhammad F, Akhtar B, et al. Is cannabidiol a promising substance for new drug development? A review of its potential therapeutic applications. Critical Reviews in Eukaryotic Gene Expression. 2018;28(1):73-86.
Ogle WL, Gold GJ, Coppen LE,Copriviza C. How and why adults use cannabis during physical activity. Journal of Cannabis Research. 2022;4(24), 1-10.
Olson TP, Dengel DR, Leon AS, et al. Moderate resistance training and vascular health in overweight women. Med Sci Sports Exerc. 2006;38(9):1558-1564.
Pierce GL, Eskurza I, Walker AE, et al. Sex specific effects of habitual aerobic exercise on brachial artery flow-mediated dilation in middle-aged and older adults. Clin Sci (Lond). 2008;120(1):1-17.
Pinzone AG, Erb EK, Humm SM, et al. Cannabis use for exercise recovery in trained individuals: a survey study. Journal of Cannabis Research. 2023;5:32. https://doi.org/10.1186/s42238-023-00198-5
Rakobowchuk M, McGowan CL, de Groot PC, et al. Endothelial function of young healthy males following whole body resistance training. J Appl Physiol. 2005;98:2185-2190.
Renaud AM, Cormier Y. Acute effects of marihuana smoking on maximal exercise performance. Medicine and Science in Sports and Exercise. 1986;18(6), 685–689.
Rojas-Valverde D. Potential role of cannabidiol on sports recovery: A narrative review. Front Physiol. 2021;12(722550). doi: 10.3389/fphys.2021.722550.
Rosenkrantz H, Fleischman RW, Grant RJ. Toxicity of short-term administration of cannabinoids to rhesus monkeys. Toxicol Appl Pharmacol. 1981;58(1):118-131.
Sawyer, BJ, Tucker WJ, Bhammar DM, et al. Effects of high-intensity interval training and moderate-intensity continuous training on endothelial function and cardiometabolic risk markers in obese adults. Journal of Applied Physiology. 2016;121(1):279-288. https://doi.org/10.1152/japplphysiol.00024.2016
Schubert MM, Hibbert JE, Armenta R, Willis EA. Cannabis and cannabidiol use in active individuals: A survey of timing and reasons for use. International Journal of Exercise Science: Conference Proceedings. 2021;14(1), 53.
Stanley CP, Hind WH, Tufarelli C, O’Sullivan SE. Cannabidiol causes endothelium-dependent vasorelaxation of human mesenteric arteries via CB1 activation. Cardiovascular Research. 2015;107(4):568-578.
Steadman RD, Singh M. The effects of smoking marihuana on physical performance. Medicine & Science in Sports. 1975;7(4), 309–311.
Sultan SR, Millar SA, O'Sullivan SE, England TJ. A systematic review and meta-analysis of the haemodynamic effects of cannabidiol. Front Pharmacol. 2017;8:1-13.
Sultan SR, O’Sullivan SE, England TJ. The effects of acute and sustained cannabidiol dosing for seven days on the haemodynamics in healthy men: A randomised controlled trial. British Journal of Clinical Pharmacology. 2020;86(6):1125-1138.
Thijssen DHJ, Black MA, Pyke KE, et al. Assessment of flow-mediated dilation in humans: A methodological and physiological guide. Am J Physiol Heart Circ Physiol. 2011;300:H2-H12.
Walsh JH, Yong G, Cheetham C, et al. Effects of exercise training on conduit and resistance vessel function in treated and untreated hypercholesterolaemic subjects. European Heart Journal. 2003;24:1681-1689.
Windmer RJ, Lerman A. Endothelial dysfunction and cardiovascular disease. Glob Cardiol Sci Pract. 2014;43:291-308.
World Anti-Doping Agency (WADA). WADA executive committee approves 2023 prohibited list. 2022 Sept. https://www.wada-ama.org/en/questions-answers/cannabinoid.
World Health Organization (WHO). Cannabidiol (CBD): Critical review report. 2018. https://www.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabis
Kumric M, Dujic G, Vrdoljak J, Svagusa K, Kurir TT, Supe-Domic D, Dujic Z, Bozic J. CBD supplementation reduces artieral blood pressure via modulation of the sympatho-chromaffin system: A substudy from the HYPER-H21-4 trial. Biomedicine & Pharmacothearpy. 2023;160:114387.
Miočić J, Androja L. Understanding the significance of cannabidiols and their possible use in sport. International Journal of Innovative Science and Research Technology. 2020;5(7):1371-1374.
YorkWilliams S, Gust CJ, Mueller R, et al. The new runner’s high? Examining relationships between cannabis use and exercise behavior in states with legalized cannabis. Frontiers in Public Health. 2018;7:1-7.
Sacco LN. The evolution of marijuana as a controlled substance and the federal-state policy gap. Congressional Research Service Report. 2022. https://crsreports.congress.gov/product/pdf/R/R44782
Grotenhermen F, Russo E, Zuardi AW. Even High Doses of Oral Cannabidol Do Not Cause THC-Like Effects in Humans: Comment on Merrick et al. Cannabis and Cannabinoid Research 2016;1(1):102-112; DOI: 10.1089/can.2015.0004. Cannabis Cannabinoid Res. 2017 Jan 1;2(1):1-4. doi: 10.1089/can.2016.0036. PMID: 28861499; PMCID: PMC5531368.
Russo E, Guy GW. A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol. Med Hypotheses. 2006;66(2):234-46. doi: 10.1016/j.mehy.2005.08.026. Epub 2005 Oct 4. PMID: 16209908.
Devinsky O, Marsh E, Friedman D, Thiele E, Laux L, Sullivan J, Miller I, Flamini R, Wilfong A, Filloux F, Wong M, Tilton N, Bruno P, Bluvstein J, Hedlund J, Kamens R, Maclean J, Nangia S, Singhal NS, Wilson CA, Patel A, Cilio MR. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol. 2016 Mar;15(3):270-8. doi: 10.1016/S1474-4422(15)00379-8. Epub 2015 Dec 24. Erratum in: Lancet Neurol. 2016 Apr;15(4):352. PMID: 26724101.
Huestis MA, Solimini R, Pichini S, Pacifici R, Carlier J, Busardo FP. Cannabidiol adverse effects and toxicity. Curr Neuropharmacol. 2019 Oct;17(10):974-989.
Devinsky O, Marsh E, Friedman D, Thiele E, Laux L, Sullivan J, Miller I, Flamini R, Wilfong A, Filloux F, Wong M, Tilton N, Bruno P, Bluvstein J, Hedlund J, Kamens R, Maclean J, Nangia S, Singhal NS, Wilson CA, Patel A, Cilio MR. Cannabidiol in patients with treatment-resistant epilepsy: An open-label interventional trial. Lancet Neurol. 2016;15:270-278.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Kirsten L. Thornhill, MS, Dr. Thomas Cappaert (Author)