Frequent Cannabis Use Tied to Coronary Artery Disease

Marlene Busko

February 28, 2023

A two-part research study suggests that frequent cannabis is a risk factor for coronary artery disease (CAD).

In the first part, in an observational study, daily cannabis use was associated with 34% higher odds for CAD compared with never-users in a large population-based US cohort. Less frequent use was not associated with increased odds for CAD.

In the second part, people with a genetic susceptibility to cannabis use disorder or severe cannabis dependency had an increased risk for CAD compared with other people.

Ishan Paranjpe, MD, the study's lead author, reported these results in a press briefing and will present the study at the upcoming American College of Cardiology (ACC) Scientific Session/World Congress of Cardiology (WCC) 2023.

Dr Ishan Paranjpe

"A couple of takeaway points are that daily cannabis use, but not less frequent cannabis use was associated with CAD" in the large population-based cohort, said Paranjpe, a resident physician at Stanford University, California, during the press conference.

"This analysis was adjusted for several possible confounders including age, sex at birth, [body mass index (BMI)], race, education, cigarette use, hypertension, high cholesterol, and diabetes," he noted, and even after accounting for these risk factors, the association with heart disease remained.

"And the next thing, using Mendelian randomization, we sort of implied that there might be a causal relationship between cannabis and heart disease. Importantly this effect is independent of alcohol and cigarette use.

"The notion that cannabis is completely benign is probably wrong, and there might be certain risk of certain cardiovascular effects of cannabis we should be more on the lookout for," Paranjpe said in an interview with | Medscape Cardiology.

"Our main conclusion was that prevalent CAD is associated with cannabis consumption," he added. "Other mechanistic work published in Cell, has also shown that cannabis causes vascular inflammation that may lead to CAD.

"Thus, there is growing evidence from both laboratory and population studies that cannabis consumption may be harmful for cardiovascular health," he said. "However, we still need more work on whether it affects the risk of incident cardiovascular events (ie, stroke, heart attack) in patient[s] with existing CAD."


Invited to comment, Robert L. Page II, PharmD, chair of the writing group for the American Heart Association's scientific statement Medical Marijuana, Recreational Cannabis, and Cardiovascular Health, published in 2020, said, "this adds to our hypothesis that if you are using marijuana over a longer period, greater exposure, you're going to see an increase in the risk" for atherosclerotic cardiovascular disease (ASCVD).

"We're seeing this increased risk for ASCVD in young adults between ages 18 to 40 — people who think that they're invincible," Page, a professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, who was not involved with this research, told | Medscape Cardiology in an interview.

"The bottom line is that the risk that they are seeing is what has also been documented in other observational studies, and it adds fuel to the fire. We need to be paying close attention to this," he said.

"Primary care [clinicians], cardiologists, need to address this, particularly in younger adults — because that's where you're seeing the highest amount of use."

"All of Us" Observational Study

In the first part of the study, the researchers analyzed data from the "All of Us" cohort comprising adults age 18 and older from 340 inpatient and outpatient sites across the United States.

They identified 57,958 individuals who replied to a questionnaire asking about cannabis use (medicinal or recreational and whether it was edible or used by smoking or vaping) over the past 3 months.

There were 39,678 never-users, 8749 who used it once or twice, 2075 who used it monthly, 2720 who used it weekly, and 4736 who used it daily.

Of these, 3506 individuals had CAD, based on medical records.

Only daily users had a significantly higher risk for CAD compared with never-users (odds ratio [OR], 1.34; P = .001) after adjusting for age, sex, hypertension, hyperlipidemia, type 2 diabetes, BMI, education, insurance status, and cigarette use.

The median age for daily users was 41, whereas the median age for never-users was 59.

GWAS Analyses

The researchers then performed a Mendelian randomization analysis based on genome-wide association studies (GWAS) of cannabis use disorder and of CAD.

"Cannabis use disorder is a psychiatric diagnosis of severe cannabis dependency, equivalent to 'alcohol use disorder' for alcohol consumption," Paranjpe explained. "The exact definition involves frequent use leading to significant dependence (but does not specify how often it is used)."

The GWAS data for cannabis use disorder came from a recent meta-analysis of three cohorts: the Psychiatric Genomics Consortium Substance Use Disorders working group, iPSYCH, and deCODE.

The GWAS statistics for CAD were obtained from the CARDIoGRAMplusC4D Consortium.

Cannabis use disorder was associated with significantly increased odds for CAD (OR, 1.05; P = .001), which remained after adjusting for both cigarette and alcohol use (OR, 1.04; P = 1.07).

American College of Cardiology (ACC) Scientific Session/World Congress of Cardiology (WCC) 2023: Abstract #1458-186. To be presented March 5, 2023.

For more from | Medscape Cardiology, join us on Twitter and Facebook.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.