Abstract
We report a case of sudden death due to acute coronary syndrome (ACS) in a young cannabis user. A man in his late thirties died at home, and marijuana was found. The autopsy revealed severe occlusion by an atherosclerotic plaque in the left anterior descending artery. The histopathological examination revealed ischemic changes, likely caused by cannabis-induced sympathetic β-adrenergic stimulation. Both cannabinoid receptors (CB1 and CB2) were expressed in the atherosclerotic lesions. The CB2 expression was higher than CB1 expression in the atherosclerotic plaque, corresponding to macrophage infiltration. Since cannabis is regarded as a casual drug due to its lower levels of dependency, some individuals have supported legalized marijuana use. However, this case report will provide cautions on the casual use of cannabis.