Use of Cannabis Linked to Increase in Heart Attack and Stroke Risk
Just when marijuana is getting legalized across the country, new research published in the Journal of the American Heart Association in 430,000 US adults found that cannabis use through smoking, eating, or vaping was linked with risk of heart attack, stroke, and other cardiovascular risk factors despite controlled for tobacco use including cigarettes and chewing tobacco.
At the federal level, marijuana (cannabis) is not legal but in 24 states and Washington DC, the use of recreational cannabis use has been legalized. Based on the 2019 National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services. The use of cannabis in the US in recent decades has increased significantly.
In 2019, the annual survey discovered that 48.2 million people ages 12 or older reported using cannabis at least once, compared to 25.8 million people ages 12 or older in 2002, an increase from 11% to 17%.
Lead study author Abra Jeffers, Ph.D., a data analyst at Massachusetts General Hospital in Boston, states, “"Despite common use, little is known about the risks of cannabis use and, in particular, the cardiovascular disease risks. The perceptions of the harmfulness of smoking cannabis are decreasing, and people have not considered cannabis use dangerous to their health. However, previous research suggested that cannabis could be associated with cardiovascular disease. In addition, smoking cannabis -- the predominant method of use -- may pose additional risks because particulate matter is inhaled."
Researchers evaluated survey data collected in 430,000 adults between 2016 and 2020 to review the link between marijuana use and adverse cardiovascular outcomes such as heart disease, heart attack, and stroke. Data was obtained through the Behavioral Risk Factor Surveillance System, a national, cross-sectional survey completed each year by the U.S. Centers for Disease Control and Prevention.
Cannabis use and adverse cardiovascular outcomes in the general adult population, in people who never smoked or used e-cigarettes, and among men under the age of 55 and women under the age of 65 at risk for heart disease were investigated by the researchers. The number of days per month that cannabis was used was also considered.
The analyses found:
· Any use of cannabis (smoked, eaten or vaporized) was independently linked with a higher number of adverse cardiovascular outcomes (coronary heart disease, myocardial infarction and stroke). When used more often (more days per month), the odds of adverse outcomes were even higher. After controlling for other cardiovascular risk factors, such as tobacco and/or e-cigarette use, alcohol intake, body mass index, Type 2 diabetes and physical activity, the results were similar.
· Daily and non-daily cannabis users both had an increased risk of heart attack compared those who didn’t use; daily cannabis users had 25% higher odds of heart attack compared to non-users.
· In daily cannabis users, the odds for stroke were 42% higher compared to non-users, those who used cannabis less than daily had lower risk among
· In men younger than 55 years old and women younger than 65 years old, defined as “young adults”, at risk for premature cardiovascular disease, use of cannabis was significantly linked with 36% higher combined odds of coronary heart disease, heart attack and stroke. This was seen regardless of whether or not they also used traditional tobacco products.
· A separate analysis of a smaller subgroup of these adults who had never smoked tobacco cigarettes or used nicotine e-cigarettes also discovered a significant link between cannabis use and an increase in the combined odds of coronary heart disease, heart attack and stroke.
Jeffers explained, "Our sample was large enough that we could investigate the association of cannabis use with cardiovascular outcomes among adults who had never used tobacco cigarettes or e-cigarettes,". He continues to say that smoke from cannabis is not much different than tobacco except for its psychotropic drug THS versus nicotine.
The study indicates that cannabis use has major cardiovascular risks similar to smoking tobacco. As cannabis use is increasing, traditional tobacco use is decreasing.
Study details and background
· The average age of subjects was 45 years with survey participants between ages 18-74
· Roughly half of the subjects self-identified as female. 60.2% self-identified as white adults, 11.6 self-identified as Black adults, 19.3 self-identified as Hispanic adults and 8.9% self-identified as other.
· Almost 90% of adults had no cannabis use, 7% used it less than daily; and 4% used it daily. Within current cannabis users, 73.8% reported smoking as the most common form of cannabis use. Over 60% of all responders had never used tobacco cigarettes; 28.6% of daily cannabis users had never used tobacco cigarettes; 44.6% of non-daily cannabis users had never used tobacco cigarettes and nearly 64% of participants who did not use cannabis had never used tobacco cigarettes.
Limitations in the study were observed including that cannabis use and cardiovascular conditions were self-reported, which could make them potentially subject to recall bias (potential memory errors). In addition, the authors did not have baseline health data such as participants' baseline lipid profile or blood pressure; the study captured data for only a single point in time for the participants.
The authors suggest there’s a need for prospective cohort studies -- studies that follow groups of individuals over some time -- to examine the link between cannabis use and cardiovascular outcomes while factoring in how often cannabis is used.
Robert L. Page II, Pharm.D., M.S.P.H., FAHA, chair of the volunteer writing group for the 2020 American Heart Association Scientific Statement: Medical Marijuana, Recreational Cannabis, and Cardiovascular Health believes, "The findings of this study have very important implications for population health and should be a call to action for all practitioners, as this study adds to the growing literature that cannabis use and cardiovascular disease may be a potentially hazardous combination,".
Page who was not involved in the study is professor of clinical pharmacy, medicine and physical medicine at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado School of Medicine in Aurora, Colorado.
Page is concerned that, "In the overall population, the study findings are consistent with other studies indicating that daily cannabis use was associated with an increase in heart attack, stroke and the combined endpoint of coronary heart disease, heart attack and stroke. As cannabis use continues to grow in legality and access across the U.S., practitioners, and clinicians need to remember to assess cannabis use at each patient encounter to have a non-judgmental, shared decision conversation about potential cardiovascular risks and ways to reduce those risks."
To reduce cardiovascular risks overall:
· Don’t smoke! Tobacco, cannabis use or vaping are all damaging and increase the risk for cardiovascular conditions as well as lung disease.
· Consider meditation or other methods of relaxation versus cannabis use
· Eat a diet low in fat and saturated fat to reduce the risk of heart disease and stroke.
· Do regular exercise to reduce total and low-density lipoprotein (LDL) and increase HDL (high density lipoprotein)
· Keep alcohol intake moderate. Even one drink per day raises blood pressure.
Lisa Andrews, MEd, RD, LD
Journal Reference:
Abra M. Jeffers, Stanton Glantz, Amy L. Byers, Salomeh Keyhani. Association of Cannabis Use With Cardiovascular Outcomes Among US Adults. Journal of the American Heart Association, 2024; DOI: 10.1161/JAHA.123.030178
