Lifetime Cannabis Use Linked to 5x Higher Odds of Coronary Heart Disease in Young and Middle-Aged Adults
In nearly 3,000 U.S. adults aged 20-59, lifetime cannabis use was associated with 5.45 times higher odds of coronary heart disease — a striking finding from NHANES data, though cross-sectional design limits causal conclusions.
Quick Facts
What This Study Found
Cardiovascular disease is increasingly affecting younger adults, and this study examined whether lifetime substance use — including cannabis — might contribute. Using nationally representative NHANES data from 2017-2018, the researchers analyzed 2,933 adults aged 20-59.
The headline finding is hard to ignore: adults who had ever used cannabis had 5.45 times higher odds of reporting coronary heart disease. That's a large effect size — much larger than the modest associations typically seen in cannabis-cardiovascular research. Cigar use was associated with 2.31 times higher odds of stroke, and e-cigarettes and smokeless tobacco were associated with higher odds of hypertension.
But the magnitude of the cannabis-coronary heart disease association demands critical scrutiny. This is a cross-sectional study using self-reported lifetime cannabis use (ever/never) and self-reported cardiovascular diagnoses. 'Lifetime cannabis use' includes everyone from someone who tried cannabis once at age 18 to a daily user for 30 years — a category so broad it's hard to know what it means biologically.
The odds ratio could be inflated by residual confounding: cannabis users may differ from non-users in tobacco use, diet, exercise, stress, socioeconomic status, and healthcare access in ways that the multivariable adjustment didn't fully capture. The use of self-reported cardiovascular diagnoses rather than clinical records adds another layer of uncertainty.
Still, the finding is consistent with a growing body of evidence suggesting cannabis isn't cardiovascular-neutral, even if the true effect size is likely smaller than the 5.45x reported here.
Key Numbers
2,933 adults aged 20-59 from NHANES 2017-2018. Lifetime cannabis use: OR 5.45 (95% CI: 1.86-15.95) for coronary heart disease. Cigar use: OR 2.31 (95% CI: 1.06-5.01) for stroke. E-cigarette use: OR 1.41 (95% CI: 1.12-1.79) for high blood pressure. Smokeless tobacco: OR 1.46 (95% CI: 1.01-2.12) for high blood pressure.
How They Did This
Cross-sectional analysis of 2,933 adults aged 20-59 from NHANES 2017-2018. CVD defined as self-reported healthcare provider diagnosis of coronary heart disease, stroke, or high blood pressure. Substance use assessed as ever-use of cannabis, non-cigarette tobacco products, or illicit drugs. Adjusted odds ratios estimated using multivariable logistic regression.
Why This Research Matters
Cardiovascular disease in young and middle-aged adults is increasing, and identifying modifiable risk factors is critical. If cannabis genuinely increases coronary heart disease risk to the degree suggested here, it would be one of the most important cardiovascular findings in cannabis research. But the cross-sectional, self-reported design means this is a signal that demands better-designed studies, not a definitive answer.
The Bigger Picture
This finding needs to be read alongside RTHC-00103 (183-million-patient meta-analysis), which found cannabis associated with stroke risk but not heart attack risk. The much larger meta-analysis found a more modest association, suggesting the 5.45x odds ratio here may be inflated by confounding or the limitations of self-reported data. RTHC-00122 (cardiovascular effects by route) adds the important detail that smoking is likely the highest-risk route. Together, these studies suggest cannabis has cardiovascular effects worth monitoring, but the magnitude remains debated.
What This Study Doesn't Tell Us
Cross-sectional design — cannot establish temporal ordering or causation. Ever-use of cannabis is an extremely broad exposure definition that doesn't distinguish occasional from chronic use. Self-reported CVD diagnoses are less reliable than clinical records. Relatively wide confidence interval (1.86-15.95) indicates imprecision. Residual confounding from tobacco, alcohol, diet, exercise, and other factors is a significant concern. NHANES 2017-2018 is a single survey cycle with a modest sample for subgroup analysis of relatively rare outcomes like coronary heart disease in young adults.
Questions This Raises
- ?Would a prospective cohort study with clinically confirmed CVD outcomes replicate this association?
- ?Is the 5.45x odds ratio driven by confounding (especially concurrent tobacco use) rather than cannabis itself?
- ?Does route of administration (smoking vs. other) explain the cardiovascular association?
- ?Would dose-response analysis (frequency/duration of cannabis use rather than ever/never) provide a more accurate picture?
Trust & Context
- Key Stat:
- Evidence Grade:
- Cross-sectional analysis of nationally representative NHANES data. The large sample and national representativeness are strengths, but the cross-sectional design, self-reported outcomes, and broad exposure definition (ever-use) significantly limit causal inference.
- Study Age:
- Published in 2025 using 2017-2018 NHANES data. More recent NHANES cycles may provide updated estimates.
- Original Title:
- Lifetime Cannabis, Non-Cigarette Tobacco, and Illicit Drug Use and Cardiovascular Disease Among Young and Middle-Aged U.S. Adults.
- Published In:
- American journal of lifestyle medicine, 15598276251404883 (2025) — The American Journal of Lifestyle Medicine focuses on lifestyle factors affecting health and wellness.
- Authors:
- Agbonlahor, Osayande(2), Mattingly, Delvon T(2), Hart, Joy L(2), Richardson, Maggie K, McLeish, Alison C, Walker, Kandi L
- Database ID:
- RTHC-05874
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Read More on RethinkTHC
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Cite This Study
https://rethinkthc.com/research/RTHC-05874APA
Agbonlahor, Osayande; Mattingly, Delvon T; Hart, Joy L; Richardson, Maggie K; McLeish, Alison C; Walker, Kandi L. (2025). Lifetime Cannabis, Non-Cigarette Tobacco, and Illicit Drug Use and Cardiovascular Disease Among Young and Middle-Aged U.S. Adults.. American journal of lifestyle medicine, 15598276251404883. https://doi.org/10.1177/15598276251404883
MLA
Agbonlahor, Osayande, et al. "Lifetime Cannabis, Non-Cigarette Tobacco, and Illicit Drug Use and Cardiovascular Disease Among Young and Middle-Aged U.S. Adults.." American journal of lifestyle medicine, 2025. https://doi.org/10.1177/15598276251404883
RethinkTHC
RethinkTHC Research Database. "Lifetime Cannabis, Non-Cigarette Tobacco, and Illicit Drug U..." RTHC-05874. Retrieved from https://rethinkthc.com/research/agbonlahor-2025-lifetime-cannabis-noncigarette-tobacco
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.