Among individuals without significant cardiovascular morbidity younger than 50 years, the use of cannabis is linked to adverse cardiovascular events, including a sixfold higher risk of a myocardial infarction (MI), fourfold increase risk of ischemic stroke, twofold increased risk of heart failure (HF) and threefold increased risk of cardiovascular death, MI or stroke, according to a brief report published March 18 in JACC: Advances and being presented at ACC.25 in Chicago. The findings suggest cannabis as a novel and underrecognized risk factor for cardiovascular disease.

Ibrahim Kamel, MD, MHA, et al., conducted a retrospective cohort study using data from TriNetX, a global health research network that provides access to electronic medical records. They examined data collected between 2010 and 2018 in U.S. adults ≤50 years who were free of significant comorbidities at baseline, including hypertension, hyperlipidemia or LD L>100 mg/dL, coronary artery disease including prior MI or history of coronary interventions, diabetes or HbA1c >7, and tobacco use.

Of a total of 4,636,628 individuals included in the analysis, 93,267 (2.01%) were cannabis users. They were older than nonusers (26 vs. 21 years); had more comorbidities, including a nearly 15-fold higher prevalence of depressive episode (30.63% vs. 1.88%); and more had a BMI >30 (18.72% vs. 3.25%). After propensity score matching, each group had 89,776 patients with balanced demographics and baseline health characteristics. The mean follow-up for cannabis users was 35.7 months for cannabis users and 44.2 months for nonusers.

Results showed that for the primary outcome of MI, the absolute risk was 0.558% in cannabis-users vs. 0.09% in nonusers; the risk difference was 0.468%, the risk ratio was 6.185, and the odds ratio was 6.214.

In cannabis users vs. nonusers, the absolute risk for ischemic stroke was 0.405% and 0.094%; for major adverse clinical events, 1.187% vs. 0.366%; for HF, 0.861% vs. 0.424%; and for all-cause mortality, 1.262% vs. 0.841%.

The authors write that cannabis use appears to pose a substantial and independent risk for these outcomes, even in a population without traditional cardiovascular risk factors.

"Asking about cannabis use should be part of clinicians' workup to understand patients' overall cardiovascular risk, similar to asking about smoking cigarettes," said Kamel. "At a policy level, a fair warning should be made so that the people who are consuming cannabis know that there are risks."