An analysis of the National Inpatient Sample database found that cannabis use was an independent predictor of heart failure (OR 1.1) and cerebrovascular accident (OR 1.24) in adults aged 18-55 after adjusting for traditional cardiovascular risk factors.
Cardiologists; primary care physicians counseling patients about cannabis use; public health researchers studying cardiovascular effects of cannabis legalization.
Cannabis independently predicted stroke (OR 1.24) and heart failure (OR 1.1) in adults under 55
What the researchers found
Researchers identified cannabis users aged 18-55 in the National Inpatient Sample 2009-2010 database and compared their cardiovascular outcomes to the general population.
Prevalence of heart failure, stroke, coronary artery disease, sudden cardiac death, and hypertension were all significantly higher in cannabis users.
After multivariate regression adjusting for age, sex, hypertension, diabetes, hyperlipidemia, coronary artery disease, tobacco use, and alcohol use, cannabis use remained an independent predictor of heart failure (OR 1.1, 95% CI 1.03-1.18) and stroke (OR 1.24, 95% CI 1.14-1.34).
The stroke association was notably stronger than the heart failure association.
Why it matters
As cannabis use becomes more widespread, understanding cardiovascular risks matters for public health. This large database study suggests cannabis may carry independent cardiovascular risk even in younger adults, a population typically considered low-risk for heart failure and stroke.
The numbers in context
Cannabis use independently predicted heart failure (OR 1.1, 95% CI 1.03-1.18, p < 0.01) and stroke (OR 1.24, 95% CI 1.14-1.34, p < 0.001) after adjusting for age, sex, hypertension, diabetes, hyperlipidemia, coronary artery disease, tobacco, and alcohol use.
How the study worked
Retrospective analysis of the National Inpatient Sample 2009-2010. Cannabis use identified by ICD-9 code 304.3 (cannabis dependence). Multivariate logistic regression adjusting for traditional cardiovascular risk factors.
What this study cannot tell us
Retrospective database study relying on ICD-9 codes, which likely undercount cannabis use and only capture those with documented cannabis dependence. Cannot determine dose, frequency, or method of cannabis use. Cannot establish causation. Hospitalized patients may not represent all cannabis users.
How to read the evidence
Moderate. Large national database with appropriate statistical adjustments, but retrospective design and reliance on diagnostic codes limit causal conclusions.
When this study was published
Published in 2018 using 2009-2010 data. Cannabis cardiovascular research has continued to expand as legalization spreads.
The bigger picture
This adds to a growing body of evidence suggesting cannabis use may carry cardiovascular risks that are not fully explained by concurrent tobacco or alcohol use. However, database studies using diagnostic codes have inherent limitations in capturing the full picture of cannabis exposure.
Questions still open
- Is there a dose-response relationship between cannabis use and cardiovascular events? Does the method of consumption (smoking vs. edibles) affect cardiovascular risk? Are younger cannabis users at different risk than older users?
Common questions
Does this prove cannabis causes heart failure and stroke?
What is an odds ratio of 1.24?
Read the original research
Cannabis use predicts risks of heart failure and cerebrovascular accidents: results from the National Inpatient Sample.
Journal of cardiovascular medicine (Hagerstown, Md.), 19(9), 480-484
Citation
Kalla, Aditi; Krishnamoorthy, Parasuram M; Gopalakrishnan, Akshaya; Figueredo, Vincent M. (2018). Cannabis use predicts risks of heart failure and cerebrovascular accidents: results from the National Inpatient Sample.. Journal of cardiovascular medicine (Hagerstown, Md.), 19(9), 480-484. https://doi.org/10.2459/JCM.0000000000000681
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