Does Smoking Cannabis Increase Heart Attack and Stroke Risk in Older Veterans?

Prospective observational cohort study. 4,285 veterans (mean age 67.5, 2% female) with coronary artery disease, born 1950–1952, recruited April 2018 to March 2020. Cannabis smoking status classified by self-report in the past 30 days. Separate analysis for any cannabis use (smoking, vaping, edibles). Primary outcome: composite of fatal/nonfatal stroke, fatal/nonfatal MI, and cardiovascular death. Data from telephone interviews, VA records, and Medicare claims.

The intersection of aging, heart disease, and cannabis use is becoming a critical clinical question as baby boomers—the generation most likely to have used cannabis historically—age into the highest-risk period for cardiovascular disease. This study provides the first large-scale data on that intersection, though it can't definitively answer whether cannabis causes cardiovascular events or merely correlates with other risk factors.

This adds to the cardiovascular-cannabis evidence base alongside studies examining younger and healthier populations. The fact that the study focused on people with existing heart disease is important—most prior cardiovascular-cannabis studies involved general populations where baseline cardiovascular risk is low. For this high-risk group, even small increases in cardiovascular risk from cannabis could translate to meaningful clinical consequences. The route-of-administration analysis (smoking vs. any use) also matters, since smoking involves combustion byproducts that are independently harmful to blood vessels.

Observational design—cannot prove causation. Overwhelmingly male (98%) veteran population limits generalizability. Self-reported cannabis use may underestimate true prevalence. Confounders like tobacco smoking, alcohol use, and medication adherence could drive the association. The 30-day use window is a crude measure that doesn't capture dose, frequency, or potency.