Article Impact Level: HIGH Data Quality: STRONG Summary of Heart, heartjnl-2024-325429. https://doi.org/10.1136/heartjnl-2024-325429 Dr. Wilhelm Storck et al.
Points
- This systematic review and meta-analysis of 24 studies investigated the association between cannabis use and the risk of major adverse cardiovascular events like heart attack and stroke.
- The pooled data demonstrated that cannabis consumption was associated with a 29 percent heightened risk for acute coronary syndrome, which is a sudden blockage of blood flow.
- A statistically significant 20 percent increased risk for non-fatal stroke was also identified among individuals who reported using cannabis compared to non-users in the analysis.
- Most alarmingly, the research found that using cannabis was linked to a more than doubled risk of dying from cardiovascular disease, with a calculated risk ratio of 2.10.
- The findings strongly suggest that clinicians should incorporate questions about cannabis use into their standard assessment for all patients who present with serious cardiovascular health problems.
Summary
A recent systematic review and meta-analysis evaluated the association between cannabis use and major adverse cardiovascular events (MACE), defined as cardiovascular death, non-fatal acute coronary syndrome (ACS), or non-fatal stroke. Researchers searched PubMed, Web of Science, and Scopus for pharmacoepidemiological studies published between January 1, 2016, and January 31, 2023. From an initial 3,012 records, 24 articles were included in the final analysis, comprising 17 cross-sectional studies, six cohort studies, and one case-control study. The quality of these non-randomized studies was assessed using the ROBINS-E tool, and a DerSimonian and Laird random effect model was employed to pool adjusted effect estimates.
The pooled data revealed statistically significant positive associations between cannabis use and MACE. Specifically, the analysis yielded a risk ratio (RR) for ACS of 1.29 (95% CI 1.05 to 1.59) and an RR for stroke of 1.20 (95% CI 1.13 to 1.26). The risk for cardiovascular death was more than doubled, with a calculated RR of 2.10 (95% CI 1.29 to 3.42). A focused analysis restricted to the six cohort studies yielded a comparable result for the primary model (RR = 1.32, 95% CI 1.01-1.73). In contrast, a composite outcome combining ACS and stroke, which was measured in two of the included studies, was not found to have a statistically significant association with cannabis use.
The authors concluded that this analysis of real-world data demonstrates a significant association between cannabis consumption and increased risk for major adverse cardiovascular events. While acknowledging that the observational nature of the included studies precludes direct causal inference and that there was a moderate to high risk of bias, the findings are clinically significant. The primary recommendation is for clinicians to incorporate inquiry about cannabis use into the routine assessment of all patients who present with severe cardiovascular disorders, given the potential for it to be a contributing risk factor.
Link to the article: https://heart.bmj.com/content/early/2025/06/10/heartjnl-2024-325429
References Storck, W., Elbaz, M., Vindis, C., Déguilhem, A., Lapeyre-Mestre, M., & Jouanjus, E. (2025). Cardiovascular risk associated with the use of cannabis and cannabinoids: A systematic review and meta-analysis. Heart, heartjnl-2024-325429. https://doi.org/10.1136/heartjnl-2024-325429
