Cannabis use disorder was not linked to cardiovascular events overall but was associated with higher in-hospital mortality | Research

The takeaway

In a national database of nearly 40,000 hospitalized patients, cannabis use disorder was not significantly associated with cardiovascular events or cardiac arrhythmias, but was linked to significantly higher in-hospital mortality.

Hospitalists and internal medicine physicians assessing cannabis-related risk; cardiovascular researchers studying substance-related cardiac outcomes.

No cardiovascular event link but significant mortality association

What the researchers found

Among 39,992 hospitalized subjects from the National Inpatient Sample (2016-2019), cannabis use disorder was not significantly associated with cardiovascular adverse events (p=0.257), cardiac dysrhythmias (p=0.481), or hospitalization costs (p=0.481) after controlling for other variables. However, CUD was significantly associated with higher in-hospital mortality (p<0.0001).

Why it matters

The dissociation between cardiovascular events (no significant association) and mortality (significant association) is puzzling and suggests cannabis use disorder may increase death risk through non-cardiovascular pathways, or that confounders not captured in administrative data are driving the mortality finding.

The numbers in context

39,992 subjects from NIS 2016-2019. Cardiovascular events: p=0.257 (not significant). Cardiac arrhythmias: p=0.481 (not significant). Hospitalization cost: p=0.481 (not significant). In-hospital mortality: p<0.0001 (significant).

How the study worked

Retrospective study using the National Inpatient Sample database (2016-2019). 39,992 subjects classified by presence of cannabis-related disorder diagnosis. Multivariable regression controlling for covariates.

What this study cannot tell us

Administrative database with ICD coding limitations. Cannot determine cannabis dose, frequency, or route. CUD diagnosis may represent a different population than general cannabis users. Cannot determine cause of death to understand the mortality association.

How to read the evidence

Large national database with multivariable adjustment, though administrative data and inability to determine cause of death limit interpretation.

When this study was published

2024 study

The bigger picture

This study challenges the narrative that cannabis primarily threatens cardiovascular health, finding no significant association with cardiac events. The mortality finding requires further investigation to understand what mechanisms might be responsible.

Questions still open

What causes the mortality association if not cardiovascular events? Is the mortality finding driven by other comorbidities associated with CUD that were not fully controlled?

Common questions

Does this mean cannabis is safe for the heart?

The study found no significant association between CUD and cardiovascular events in hospitalized patients, but other studies have found cardiac associations. The mortality finding adds complexity. More research is needed.

Why might mortality be higher without more cardiovascular events?

The study did not determine cause of death. Higher mortality could reflect non-cardiac factors like respiratory issues, accidents, interactions with other conditions, or residual confounding from substance use patterns associated with CUD.

Read the original research

The effects of cannabis use on major adverse cardiovascular outcomes, mortality, cost of hospitalization, and cardiac arrhythmias: A Retrospective analysis using the national inpatient sample.

Current problems in cardiology, 49(11), 102788

View on PubMed ↗Publisher’s paper ↗

Citation

Elsadek, Rabab; Ismail, Zeeshan; Al-Ani, Hashim; Loseke, Isaac; Fikry, Mona; Meadows, Robyn; Zentko, Suzanne; Curry, Bryan. (2024). The effects of cannabis use on major adverse cardiovascular outcomes, mortality, cost of hospitalization, and cardiac arrhythmias: A Retrospective analysis using the national inpatient sample.. Current problems in cardiology, 49(11), 102788. https://doi.org/10.1016/j.cpcardiol.2024.102788