Many people think cannabis is “medicine” and so ignore its heath effects. Abra Jeffers, Amy Byers, Salome Keyhani and I just published Association of cannabis use with cardiovascular outcomes among US adults in the Journal of the American Heart Association that found that cannabis use is associated with adverse cardiovascular events with heavier use (more days per month) associated with higher odds of disease.
We combined data from the 2016 to 2020 CDC Behavioral Risk Factor Surveillance System from 27 American states and 2 territories to examine the association between cannabis use and cardiovascular disease, controlling for cigarette smoking, age, sex, race and ethnicity, body mass index, diabetes, alcohol use, educational attainment, and physical activity in 434,104 people age 18-74. We also controlled for how many days per month people used cannabis.
Cannabis use was associated with significantly increased odds of having had a heart attack (myocardial infarction, MI) of 1.25 (95% CI, 1.07–1.46), meaning that there was a 25% increased odds of MI among adults using cannabis daily compared with nonuse, with lower odds for less than daily use. Controlling for other risk factors, cannabis use had similar dose–response relationships with stroke (aOR, 1.42 [95% CI, 1.20–1.68]) and the composite of MI, coronary heart disease, and stroke (aOR, 1.28 [95% CI, 1.13–1.44]).
We did several additional analyses and found that the results were very robust. Most notably, we found an association between cannabis use and cardiovascular outcomes in never smokers. Among never‐tobacco smokers, daily cannabis use was also associated with myocardial infarction (aOR, 1.49 [95% CI, 1.03–2.15]), stroke (aOR, 2.16 [95% CI, 1.43–3.25]), and the composite of coronary heart disease, myocardial infarction, and stroke (aOR, 1.77 [95% CI, 1.31–2.40]). This finding eliminates the possibility that the main findings were due to confounding between cannabis use and tobacco smoking. Indeed, the effects of cannabis use and tobacco smoking were similar and additive; using both was riskier than using either one separately.
The paper concludes:
Cannabis has strong, statistically significant associations with adverse cardiovascular outcomes independent of tobacco use and controlling for a range of demographic factors and outcomes. It remains positively associated with cardiovascular disease among the general population, and men <55 years old and women <65 years old, those who have never use tobacco cigarettes, and those who have never used tobacco cigarettes or e‐cigarettes. 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.
Here is the abstract:
Background. We examined the association between cannabis use and cardiovascular outcomes among the general population, among never‐tobacco smokers, and among younger individuals.
Methods and Results. This is a population‐based, cross‐sectional study of 2016 to 2020 data from the Behavioral Risk Factor Surveillance Survey from 27 American states and 2 territories. We assessed the association of cannabis use (number of days of cannabis use in the past 30 days) with self‐reported cardiovascular outcomes (coronary heart disease, myocardial infarction, stroke, and a composite measure of all 3) in multivariable regression models, adjusting for tobacco use and other characteristics in adults 18 to 74 years old. 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. Among the 434 104 respondents, the prevalence of daily and nondaily cannabis use was 4% and 7.1%, respectively. The adjusted odds ratio (aOR) for the association of daily cannabis use and coronary heart disease, myocardial infarction, stroke, and the composite outcome (coronary heart disease, myocardial infarction, and stroke) was 1.16 (95% CI, 0.98–1.38), 1.25 (95% CI, 1.07–1.46), 1.42 (95% CI, 1.20–1.68), and 1.28 (95% CI, 1.13–1.44), respectively, with proportionally lower log odds for days of use between 0 and 30 days per month. Among never‐tobacco smokers, daily cannabis use was also associated with myocardial infarction (aOR, 1.49 [95% CI, 1.03–2.15]), stroke (aOR, 2.16 [95% CI, 1.43–3.25]), and the composite of coronary heart disease, myocardial infarction, and stroke (aOR, 1.77 [95% CI, 1.31–2.40]). Relationships between cannabis use and cardiovascular outcomes were similar for men <55 years old and women <65 years old.
Conclusions. Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes
The full citation is: Jeffers A, Glantz S, Byers A, Keyhani S. Association of cannabis use with cardiovascular outcomes among US adults.” J Am Heart Assn 2024; 0:e030178. https://www.ahajournals.org/doi/10.1161/JAHA.123.030178. It is available here.
News articles:
https://www.cbsnews.com/news/cannabis-use-associated-with-higher-risk-heart-attack-stroke-study
https://www.sfchronicle.com/news/article/marijuana-use-linked-to-higher-risk-of-heart-18693651.php
https://www.cnn.com/2024/02/28/health/marijuana-heart-attack-stroke-study-wellness/index.html
Press releases:
https://www.nhlbi.nih.gov/news/2024/smoking-cannabis-associated-increased-risk-heart-attack-stroke
https://newsroom.heart.org/news/cannabis-use-linked-to-increase-in-heart-attack-and-stroke-risk
Stanton Glantz blog 
This insightful study highlights the potential cardiovascular risks associated with cannabis use, even among individuals who have never smoked tobacco. The findings underscore the importance of understanding the health implications of cannabis use, particularly given the widespread perception of it as a harmless substance. With statistically significant links to myocardial infarction and stroke, especially with daily use, it’s crucial for both the public and policymakers to consider these risks seriously. As cannabis use becomes more prevalent, these findings serve as a vital reminder of the importance of informed decision-making regarding its consumption.
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While the reported odds ratios are for daily use, there is a dose-response with increasing risks associated with more days per month of use. The statistical significance tests the dose-response, not just daily use.
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