Health

Cannabis-CVD Link Holds Strong Amid Changing Drug Laws, User Habits

  • A meta-analysis of 24 observational studies confirms excess risks of heart attack, stroke, and cardiovascular death among cannabis users.
  • The report joins a growing body of evidence linking cannabis use to significant health harms.
  • Nevertheless, the meta-analysis was unable to account for cannabis mode of administration, product potency, or intensity of use.

With newer data, clear lines could still be drawn between cannabis use and major adverse cardiovascular events (MACE), a meta-analysis confirmed.

Based on two dozen pharmacoepidemiological studies published from 2016 to 2023, excess cardiovascular risks were apparent in self-reported ever-users and those detected from drug screens in the real world:

  • Acute coronary syndrome: RR 1.29, 95% CI 1.05-1.59
  • Stroke: RR 1.20, 95% CI 1.13-1.26
  • Cardiovascular death: RR 2.10, 95% CI 1.29-3.42

“These findings should encourage investigating cannabis use in all patients presenting with serious cardiovascular disorders,” concluded Emilie Jouanjus, PharmD, PhD, of University of Toulouse in France, and colleagues in their report, published in Heart.

Their previous meta-analysis, using records up to 2016, had already shown cannabis exposure to correlate with more cardiovascular disease (CVD). With this new study, the results were affirmed for a contemporary era in which cannabis use, whether medical or recreational, has gained legal status in more states and countries.

“Legalizing the drug and expanding its medical use worldwide have likely contributed to profound changes in the general perception of cannabis and to the overall rise in cannabis consumption. Consequently, users’ profiles and consumption habits profoundly differ from those in the 2010s, especially as cannabis products show an increasing trend in potency, with rising concentrations of delta-9-tetrahydrocannabinol (THC),” Jouanjus and colleagues wrote.

In fact, public health advocates Stanton Glantz, PhD, and Lynn Silver, MD, MPH, both of University of California San Francisco, pointed out that the cannabis consumed today has become even more potent since 2018, when the latest data were collected for the present meta-analysis.

“The use of higher potency products is associated in turn with increased frequent and problem use,” they wrote in an accompanying editorial. “How these changes affect cardiovascular risk requires clarification, as does the proportion of risk attributable to cannabinoids themselves versus particulate matter, terpenes, or other components of the exposure.”

Glantz and Silver said they were for a cannabis screening approach that goes even further than what Jouanjus’ group suggested.

“Cannabis use, like tobacco and alcohol use, should be assessed in all patients. At least in the USA, health professionals are the most influential source of cannabis information regardless of patient age, cannabis use, or state legal status, making it important for clinicians to ask about use, educate all patients about cannabis risks and take cannabis use into account in clinical decision making,” they wrote.

“Cardiovascular and other health risks must be considered in the regulation of allowable product and marketing design as the evidence base grows,” the duo stressed. “Specifically, cannabis should be treated like tobacco: not criminalized but discouraged, with protection of bystanders from secondhand exposure.”

Jouanjus’ group had identified 24 studies for inclusion in the updated meta-analysis.

These were a mix of cross-sectional studies, cohort studies, and one case-control study. Across the publications, mean age ranged from 19 to 59 years, and the cannabis users were predominantly men.

A sensitivity analysis restricted to cohort studies confirmed the main results, according to the investigators.

Of note, several of the reports came from the same data source at the risk of including the same patients, Jouanjus’ team cautioned. The authors also acknowledged that there is a question of the reliability of the cannabis exposure reported in these studies.

“Most just measured ‘current’, past 30-day, past year or ‘ever’ use, or a positive drug test without specifying mode of administration, product potency or intensity of use,” observed Glantz and Silver. “As a result, many of the respondents who scored as positive for cannabis use may have been light or intermittent users, which would have led to lower estimates of risk.”

Disclosures

Jouanjus, Glantz, and Silver declared no competing interests.

Primary Source

Heart

Source Reference: Storck W, et al “Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis” Heart 2025; DOI: 10.1136/heartjnl-2024-325429.

Secondary Source

Heart

Source Reference: Glantz S, Silver L “It is time to treat cannabis as an important risk factor for cardiovascular disease” Heart 2025; DOI: 10.1136/heartjnl-2024-326169.

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