Cannabis smoking produces largely identical combustion chemicals to tobacco and is associated with similar cardiovascular complications including heart attacks, arrhythmias, and strokes, potentially at younger ages.
Cardiologists, cannabis users who smoke, public health officials, and harm reduction advocates.
Similar combustion chemicals to tobacco
What the researchers found
Despite different active ingredients (THC vs nicotine), cannabis and tobacco smoke contain largely identical combustion chemicals. Cannabis-associated cardiovascular complications include acute coronary syndromes, potentially lethal arrhythmias, and ischemic strokes. Different smoking techniques (deeper inhalation, longer breath-holding) may cause longer chemical retention from cannabis.
Why it matters
The public health messaging that cannabis is "natural" and therefore safe may be masking cardiovascular risks that mirror those already well-established for tobacco, especially when smoked.
The numbers in context
The review notes that cannabis smoke contains many of the same 4,000+ chemicals as tobacco smoke, with cardiovascular complications emerging at younger ages in cannabis users.
How the study worked
Literature review of cannabis pharmacology, cardiovascular effects, comparison with tobacco effects, and special populations (adolescents, secondhand smoke, exercise).
What this study cannot tell us
Narrative review without systematic methodology. Concomitant tobacco and cannabis use confounds many studies. Dose-response data are limited. Most cardiovascular case reports are anecdotal.
How to read the evidence
Moderate: comprehensive review drawing on pharmacological, clinical, and epidemiological evidence.
When this study was published
Published in 2019.
The bigger picture
Decades of public health work to reduce tobacco smoking may be undermined if cannabis smoking normalizes the inhalation of combustion products. The cardiovascular risks appear to be an effect of combustion, not specific to either plant.
Questions still open
- Do non-combustion cannabis consumption methods (edibles, vaporizers) carry the same cardiovascular risks? Is the cardiovascular risk driven by combustion or by cannabinoids themselves?
Common questions
Is smoking cannabis as bad for the heart as smoking tobacco?
What cardiovascular problems are linked to cannabis?
Read the original research
Cannabis Associated "High" Cardiovascular Morbidity and Mortality: Marijuana Smoke Like Tobacco Smoke? A Déjà Vu/Déjà Vécu Story?
Mini reviews in medicinal chemistry, 19(11), 870-879
Citation
Manolis, Theodora A; Manolis, Antonis A; Manolis, Antonis S. (2019). Cannabis Associated "High" Cardiovascular Morbidity and Mortality: Marijuana Smoke Like Tobacco Smoke? A Déjà Vu/Déjà Vécu Story?. Mini reviews in medicinal chemistry, 19(11), 870-879. https://doi.org/10.2174/1389557518666181114113947
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