Cannabis Use as a Risk Factor for Heart Disease

A lot of the patients at the Kahn Center use cannabis products recreationally for relaxation and sleep. This comes up in conversation but is not always a routine question like questions about cigarette smoking, alcohol and exercise patterns. Is it time to add questions about cannabis use to the history taking of every patient seen at the clinic?  New data says yes. 

To put the potential probelem in perspective, cannabis use (marijuana, weed) has risen globally due to expanding legalization and social acceptance, with over 192 million users reported by the United Nations in 2018.

Cannabis consumption has been linked to adverse cardiovascular outcomes, especially myocardial infarction (MI). Research consistently shows a significant association between cannabis use and acute coronary events, particularly among younger users. However, confounding factors like tobacco or established cardiovascular risk factors limit the understanding of cannabis' long-term effects. This study aimed to evaluate the long-term cardiovascular effects of cannabis use in relatively healthy individuals. 

METHODS

This retrospective cohort study utilized the TriNetX health research network, which aggregates de-identified electronic medical records from healthcare organizations worldwide.

POPULATION

The study focused on adults aged ≤50 years between 2010 and 2018, divided into two cohorts. 1) The cannabis-user group with cannabis use diagnoses (ICD-10: F12.1, F12.9, F12.90). 2) The non-cannabis-user group. Both cohorts were free of significant comorbidities at baseline, including hypertension, hyperlipidemia or LDL>100 mg/dL, coronary artery disease including prior MI or history of coronary interventions, diabetes mellitus (DM) and tobacco use.

The relatively healthy status of these patients was a key aspect of this study design, ensuring that comparisons were not influenced by pre-existing high-risk conditions.

RESULTS

A total of 4,636,628 relatively healthy adults aged ≤50 years: 93,267 (2%) cannabis-users and 4,543,361 (98%) non-users.

Cannabis-users were older (26 vs 21) and had higher comorbidities, including a nearly 15-fold higher prevalence of depression and BMI >30.

Over 5-years, mean follow-up was 36 months for cannabis-users and 44 months for non-users.

MI absolute risk (AR) was 0.558% in cannabis-users vs. 0.09% in non-users, or a 6-fold higher risk in cannabis-users. 

For ischemic stroke, the AR was 0.405% in cannabis-users vs. 0.094% in non-users, or a 4-fold higher risk of stroke in cannabis-users.

For HF, AR was 0.861% vs.0.424%, with an RD of 0.437% or a 2-fold higher risk of heart failure in cannabis users. 

Discussion

This analysis provides evidence linking cannabis-use to adverse cardiovascular events, including MI, ischemic stroke,  and HF. Notably, cannabis use appears to pose a substantial and independent risk for these outcomes, even in a population without traditional cardiovascular risk factors. These findings suggest cannabis as a novel and underrecognized risk factor for cardiovascular diseases.

There are limitations to the study like the route of cannabis use (smoking vs. vaping vs edible) and whether other drugs were used by the subjects. 

The study's lead author said that "Asking about cannabis use should be part of clinicians' workup to understand patients' overall cardiovascular risk, similar to asking about smoking cigarettes".