Cannabis use was associated with increased risk for adverse cardiovascular outcomes in the general population even after researchers adjusted for tobacco use (combustible cigarette and e-cigarette), according to findings from a new large national study.¹

Researchers used data from the US Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS) and found that there was an increase in most incident cardiovascular outcomes among adults using cannabis daily compared with nonusers¹:

• Coronary heart disease (CHD): adjusted OR (aOR) 1.16, 95% CI 0.98-1.38
• Myocardial infarction (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

Evidence of an association between cannabis use and cardiovascular outcomes persisted in non-tobacco smokers and younger participants at risk of premature cardiovascular disease (ie, men aged less than 55 years and women aged less than 65 years), according to researchers.¹

Findings from the study were published in the Journal of the American Heart Association.¹

“Despite common use, little is known about the risks of cannabis use and, in particular, the cardiovascular disease risks,” said lead study author Abra Jeffers, PhD, data analyst, Massachusetts General Hospital, Boston, in an American Heart Association press release. “The perceptions of the harmfulness of smoking cannabis are decreasing, and people have not considered cannabis use dangerous to their health. However, previous research suggested that cannabis could be associated with cardiovascular disease. In addition, smoking cannabis—the predominant method of use—may pose additional risks because particulate matter is inhaled.”²

To gain deeper insight into the associations between cannabis consumption and cardiovascular health, Jeffers and colleagues used 2016-2020 data from the 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 (CHD, 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).¹

“We repeated this analysis among nontobacco smokers, and among men <55 years old and women <65 years old who are at risk of premature cardiovascular disease,” wrote investigators.¹

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.¹

FINDINGS

Among the 434 104 participants (mean age 45.4 years; 51.1% women; 60.2% White), the weighted prevalence of daily cannabis use was 4.0% and nondaily use was 7.1%; cannabis nonuse was 88.9%.The most common form of cannabis consumption was smoking (73.8% of current users), according to the results.¹

As previously stated, the aOR for the association of daily cannabis use and CHD, MI, stroke, and the composite outcome in the general population was 1.16 (95% CI 0.98-1.38), 1.25 (95% CI 1.07-1.46), 1.42 (95% CI 1.2-1.68), and 1.28 (95% CI 1.13-1.44), respectively. There were proportionally lower log odds for those who reported 0 to 30 days of cannabis use per month, noted Jeffers and colleagues.¹

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). Relationships between cannabis intake and cardiovascular outcomes did not differ in analyses stratified by sex.¹

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 1.16-1.61.¹

“These data suggest that cannabis use may be a risk factor for cardiovascular disease and may be a risk factor for premature cardiovascular disease. Patients and policymakers need to be informed of these potential risks, especially given the declining perception of risk associated with cannabis use,” concluded researchers.¹

References:

1. Jeffers AM, Glantz S, Byers AL, Keyhani S. Association of cannabis use with cardiovascular outcomes among US adults. J Am Heart Assoc. Published online February 28, 2024. doi:10.1161/JAHA.123.030178
2. Cannabis use linked to increase in heart attack and stroke risk. News release. American Heart Association. February 28, 2024. Accessed February 29, 2024. https://newsroom.heart.org/news/cannabis-use-linked-to-increase-in-heart-attack-and-stroke-risk