Association of Cannabis Use with Cardiovascular Outcomes

Association of Cannabis Use with Cardiovascular Outcomes Among US Adults

Journal of the American Heart Association
March 5, 2024; Vol. 13; No. 6; Article e030178

Abra M. Jeffers, PhD; Stanton Glantz, PhD; Amy L. Byers, PhD, MPH; Salomeh Keyhani, MD, MPH; the primary author is from Harvard: This study cites 44 references.

These authors assessed the association between cannabis use (primarily from smoking) and cardiovascular outcomes among the general population, among never-tobacco smokers, and among younger individuals. The assessed population was 434,104 individuals (aged 18 to 74 years) from the Behavioral Risk Factor Surveillance Survey (BRFSS), from 27 American states and 2 territories. This sample is 3 to 17 times larger than prior studies, making it very robust.

The authors controlled for tobacco smoking, age, sex, race and ethnicity, body mass index, diabetes, alcohol use, educational attainment, and physical activity.

CHD = composite of coronary heart disease
MI = myocardial infarction
OR = odds ratio

KEY POINTS FROM THIS ARTICLE:

1) In this study, the prevalence of:

• Daily cannabis use was 4%
• Occasional (median of 5 days per month) cannabis use was 7.1%
• No cannabis use was 88.9%

2) “Cannabis use is increasing in the US population.”

• “From 2002 to 2019, past-year prevalence of US adult cannabis use increased from 10.4% to 18.0%, whereas daily/almost daily use (300+ days per year) increased from 1.3% to 3.9%.” [Wow!!]

3) “Adult belief in great risk of weekly cannabis use fell from 50% in 2002 to 28.6% in 2019.”

4) Despite common use, little is known about the risks of cannabis use and cardiovascular disease.

5) “Cardiovascular-related death is the leading cause of mortality, and cannabis use could be an important, unappreciated risk factor leading to many preventable deaths.” [Important]

6) “There are reasons to believe that cannabis use is associated with atherosclerotic heart disease.”

• “Endocannabinoid receptors are ubiquitous throughout the cardiovascular system.”
• “Tetrahydrocannabinol, the active component of cannabis, has hemodynamic effects and may result in syncope, stroke, and myocardial infarction.”
• “Smoking, the predominant method of cannabis use, may pose additional cardiovascular risks as a result of inhalation of particulate matter.”
• “Secondhand cannabis smoke exposure is associated with endothelial dysfunction, a precursor to cardiovascular disease.”

7) Findings

• “There was a significant association between cannabis use and MI, [with] a 25% increased odds of MI among adults using cannabis daily compared with nonuse.” [Important]
• “Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes.”
  • “This effect exhibited a dose–response relationship, with more days of use associated with higher risks.”
• In those who had never used tobacco cigarettes and at risk for premature cardiovascular disease (men <55 years old, women <65 years old), cannabis use was significantly associated with increased risk of:
  • CHD by 136%
  • Stroke by 140%
  • Composite of CHD, MI, and stroke by 113%
• “We found that, after controlling for potential confounders, cannabis use has a strong independent effect in the general population and a strong association with cardiovascular outcomes independent of the effects of using tobacco cigarettes and e-cigarettes.”
• In the subgroup analysis (N=176,963) of those who “never used tobacco cigarettes and e-cigarettes, cannabis use had a strong positive association with stroke and the composite outcome of CHD, MI, and stroke.” [Important]
• The positive relationships between cannabis use and adverse cardiovascular outcomes are “larger for younger adults at risk of premature cardiovascular disease.”

8) “Among US adults, cannabis use is increasing in both prevalence and frequency, whereas conventional tobacco smoking is declining in prevalence.”

9) Atherosclerotic disease is a process that evolves over decades; “therefore, the contribution of cannabis use to atherosclerosis development is likely not yet fully reflected in this study.”

10) Conclusions:

• “Cannabis has strong, statistically significant associations with adverse cardiovascular outcomes independent of tobacco use and controlling for a range of demographic factors and outcomes.”
• Cannabis use is positively associated with cardiovascular disease among the general population who have never used tobacco cigarettes or e-cigarettes.
• The data suggests that cannabis use is a risk factor for cardiovascular disease and for premature cardiovascular disease.
• “Cannabis use is associated with increased risk of myocardial infarction and stroke, with higher odds of events associated with more days of use per month, controlling for demographic factors and tobacco smoking.”

11) “Patients and policymakers need to be informed of these potential risks, especially given the declining perception of risk associated with cannabis use.”

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

COMMENTS FROM DAN MURPHY:

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Article Review 30-14:
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Article Review 31-19:
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Article Review 23-21:
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Article Review 52-21:
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Article Review 8-23:
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Article Review 20-23:
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