Cannabis use linked to 2.65 times higher odds of premature heart disease in VA patients | Research

The takeaway

In a nationwide analysis of over 1.2 million VA patients, cannabis use was independently associated with 2.65 times the odds of premature cardiovascular disease, with stronger effects in women and in polysubstance users.

Cardiologists, cannabis users, and public health researchers studying cardiovascular risks of substance use.

2.65x higher odds of premature cardiovascular disease with cannabis use

What the researchers found

Cannabis use was independently associated with premature ASCVD (OR 2.65, 95% CI 2.59-2.71). Polysubstance users showed a graded response, with use of 4+ substances conferring approximately 9-fold higher risk. The association between substance use and premature ASCVD was stronger in women than men.

Why it matters

Heart disease among younger adults is rising, and recreational substance use may be a significant contributor. This massive VA dataset reveals the relative cardiovascular risk associated with each major substance, with cannabis showing a substantial independent association.

The numbers in context

135,703 premature ASCVD patients; 1,112,455 non-premature controls; cannabis use 12.5% vs 2.7%; cannabis OR 2.65; cocaine OR 2.44; amphetamine OR 2.74; 4+ substances ~9-fold risk; stronger effects in women

How the study worked

Cross-sectional analysis of the 2014-2015 nationwide VA Healthcare database and VITAL registry compared 135,703 premature ASCVD patients and 7,716 extremely premature ASCVD patients against 1,112,455 non-premature ASCVD patients using multivariable logistic regression.

What this study cannot tell us

VA population is predominantly male and may not generalize to the broader population. Cross-sectional design cannot prove causation. Substance use likely underreported in administrative data. Cannot distinguish frequency or route of use.

How to read the evidence

Massive nationwide database with multivariable adjustment, though cross-sectional design and VA population characteristics limit causal inference and generalizability.

When this study was published

Published in 2021 using 2014-2015 data.

The bigger picture

That cannabis carried cardiovascular risk on par with cocaine and amphetamines in this population challenges the perception that cannabis is cardiovascularly benign. The sex difference is also important, as cardiovascular risks in women are often underappreciated.

Questions still open

Why was the cardiovascular association stronger in women? Does the route of cannabis administration affect cardiovascular risk? Would these associations hold in a younger, non-veteran population? Is the risk driven by acute cardiovascular events or chronic vascular changes?

Common questions

How did cannabis compare to other drugs for heart disease risk?

Cannabis (OR 2.65) carried similar cardiovascular risk to cocaine (OR 2.44) and amphetamines (OR 2.74) in this study, all independently associated with premature cardiovascular disease.

Did using multiple drugs make it worse?

Yes. There was a graded response, with patients using 4 or more recreational substances having approximately 9 times the odds of premature cardiovascular disease.

Read the original research

Recreational substance use among patients with premature atherosclerotic cardiovascular disease.

Heart (British Cardiac Society), 107(8), 650-656

View on PubMed ↗Publisher’s paper ↗

Citation

Mahtta, Dhruv; Ramsey, David; Krittanawong, Chayakrit; Al Rifai, Mahmoud; Khurram, Nasir; Samad, Zainab; Jneid, Hani; Ballantyne, Christie; Petersen, Laura A; Virani, Salim S. (2021). Recreational substance use among patients with premature atherosclerotic cardiovascular disease.. Heart (British Cardiac Society), 107(8), 650-656. https://doi.org/10.1136/heartjnl-2020-318119