Cannabis Use Associated with Higher Risk of MI, Stroke: Daily Dose

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Last week, we reported on findings from a study published in the Journal of the American Heart Association that analyzed the association between cannabis use and cardiovascular outcomes among the general population, among never‐tobacco smokers, and among younger persons.

The study

Researchers used 2016-2020 data from the US Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS) from 27 US states and 2 territories. Specifically, they examined the association between cannabis use (number of days of cannabis use in the past 30 days) with self-reported cardiovascular outcomes (coronary heart disease [CHD], myocardial infarction [MI], stroke, and a composite measure of all 3) in multivariable regression models, adjusting for tobacco use and other characteristics (eg, age, sex, race, body mass index, obesity, diabetes, exercise levels, and socioeconomic status).

The sample included 434 104 BRFSS respondents aged 18 to 74 years who answered the question, “During the past 30 days, on how many days did you use marijuana or hashish?”. Researchers excluded participants who answered “Don’t know” or refused to answer.

The findings

Results showed that an increase in most incident cardiovascular outcomes among adults using cannabis daily compared with nonusers:

• CHD: adjusted OR (aOR) 1.16, 95% CI 0.98-1.38

• MI: aOR 1.25, 95% CI 1.07-1.46

• Stroke: aOR 1.42, 95% CI 1.20-1.68

• Composite of all 3: aOR 1.28, 95% CI 1.13-1.44

There were proportionally lower log odds for those who reported 0 to 30 days of cannabis use per month.

Among never-tobacco smokers, daily cannabis use was also associated with MI (aOR 1.49, 95% CI 1.03-2.15), stroke (aOR 2.16, 95% CI 1.43-3.25), and the composite outcome (aOR 1.77, 95% CI 1.31-2.4).

In supplemental analyses restricted to younger adults at risk for premature cardiovascular disease, the investigators also found cannabis use was significantly associated with CHD (aOR 1.30, 95% CI 1.00-1.67), MI (aOR 1.30, 95% CI 1.04–1.62), stroke (aOR 1.56, 95% CI 1.25–1.95), and the composite outcome (aOR 1.36, 95% CI 1.16-1.61.

Authors' comment

"Patients should be screened for cannabis use and advised to avoid smoking cannabis to reduce their risk of premature cardiovascular disease and cardiac events."

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