Cannabis use linked to 2.65 times higher odds of premature heart disease in VA patients
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- 2.65x higher odds of premature cardiovascular disease with cannabis use
- Evidence Grade:
- Massive nationwide database with multivariable adjustment, though cross-sectional design and VA population characteristics limit causal inference and generalizability.
- Study Age:
- Published in 2021 using 2014-2015 data.
- Original Title:
- Recreational substance use among patients with premature atherosclerotic cardiovascular disease.
- Published In:
- Heart (British Cardiac Society), 107(8), 650-656 (2021)
- Authors:
- Mahtta, Dhruv, Ramsey, David, Krittanawong, Chayakrit, Al Rifai, Mahmoud, Khurram, Nasir, Samad, Zainab, Jneid, Hani, Ballantyne, Christie, Petersen, Laura A, Virani, Salim S
- Database ID:
- RTHC-03311
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked 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.
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Cite This Study
https://rethinkthc.com/research/RTHC-03311APA
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
MLA
Mahtta, Dhruv, et al. "Recreational substance use among patients with premature atherosclerotic cardiovascular disease.." Heart (British Cardiac Society), 2021. https://doi.org/10.1136/heartjnl-2020-318119
RethinkTHC
RethinkTHC Research Database. "Recreational substance use among patients with premature ath..." RTHC-03311. Retrieved from https://rethinkthc.com/research/mahtta-2021-recreational-substance-use-among
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.