Young Adults Who Use Cannabis Have Worse Outcomes After Heart Attacks
Among patients under 45 hospitalized for heart attacks, cannabis users (41% of the cohort) had significantly higher rates of major cardiovascular events over a median 3-year follow-up.
Quick Facts
What This Study Found
This French study followed 188 patients under age 45 who were hospitalized for acute coronary syndrome (heart attacks and unstable angina)—all of whom were tobacco smokers. At admission, 41% tested positive for cannabis via urine testing.
Over a median follow-up of nearly 3 years, cannabis users had significantly higher rates of major adverse cardiovascular events (MACE)—a composite of death, stroke, recurrent heart attack, arrhythmia, and heart failure events. The weighted survival curves diverged significantly (p = 0.002).
The propensity-weighted analysis is important: the researchers used statistical techniques to adjust for socioeconomic and cardiovascular risk factors, trying to isolate the cannabis effect from other differences between the groups. Even after this adjustment, the association persisted.
That all participants were tobacco smokers strengthens the finding in one respect—it removes tobacco as a confounder—but also means the study is examining cannabis's cardiovascular impact on top of an already high-risk behavior. Whether cannabis would show the same association in non-smokers is unknown.
The 41% cannabis use rate among young heart attack patients is itself striking, suggesting cannabis use is very common in this population.
Key Numbers
N = 188, all under 45, all tobacco smokers. 77 (41%) tested positive for cannabis. Median follow-up: 2.93 years. Propensity-weighted survival curves: p = 0.002 for MACE difference.
How They Did This
Retrospective single-center cohort study. 188 patients under 45 admitted for acute coronary syndrome between January 2010 and March 2025, all current tobacco smokers. Cannabis use determined by urinary testing at admission. Propensity-weighted analysis adjusted for socioeconomic and cardiovascular risk factors. Primary endpoint: MACE (death, stroke, MI, arrhythmia, heart failure). Cox model truncated at 6 years.
Why This Research Matters
Heart attacks in young adults are uncommon but devastating, and understanding modifiable risk factors is critical for prevention. The 41% cannabis use rate in this population raises the question of whether cannabis contributes to both the initial event and the worse outcomes afterward. Combined with RTHC-00167's findings in older veterans with heart disease, the cardiovascular signal from cannabis is emerging across age groups.
The Bigger Picture
This is the younger counterpart to RTHC-00167's study of 4,285 veterans (average age 67) with coronary artery disease. Together, they suggest cannabis may affect cardiovascular outcomes across the age spectrum—in young adults who are just developing heart disease and in older adults who already have it. The fact that both smoking-specific and any-use analyses showed associations suggests the cardiovascular risk may extend beyond combustion byproducts.
What This Study Doesn't Tell Us
Single-center French study with a relatively small sample. Retrospective design. All participants smoked tobacco, so results can't be generalized to non-smokers. Urinary cannabis testing at admission captures recent use but not frequency, dose, or chronicity. Residual confounding is possible despite propensity weighting. No data on cannabis route of administration or product type.
Questions This Raises
- ?Would cannabis-only users (no tobacco) show the same cardiovascular risk?
- ?Is the mechanism related to acute THC effects on heart rate and blood pressure, chronic vascular inflammation, or both?
- ?Should young heart attack patients be screened for cannabis use and counseled about cardiovascular risks?
Trust & Context
- Key Stat:
- Evidence Grade:
- Retrospective cohort with propensity-weighted analysis—stronger than simple observational data but weaker than a prospective design. Published in Heart (British Cardiac Society).
- Study Age:
- Published in 2025 with 15 years of data (2010–2025), providing long-term follow-up in a young population.
- Original Title:
- Cannabis use among young adults with acute coronary syndrome: impact on initial presentation and long-term prognosis.
- Published In:
- Heart (British Cardiac Society) (2025) — Heart is a reputable journal published by the British Cardiac Society, focusing on cardiovascular research.
- Authors:
- Martin, Nicolas, Beyls, Christophe, Zeitouni, Michel, Bohbot, Yohann, Stracchi, Valentin, Sroutta-Paillusseau, Sofiane, Jarry, Geneviève, Bodeau, Sandra, Noé, Fabio, Hudelo, Julien, Fournier, Alexandre, Malaquin, Dorothée, Gabrion, Paul, Landemaine, Thomas, Vernier, Agathe, Kubala, Maciej, Leborgne, Laurent, Hermida, Alexis
- Database ID:
- RTHC-07061
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Read More on RethinkTHC
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Cite This Study
https://rethinkthc.com/research/RTHC-07061APA
Martin, Nicolas; Beyls, Christophe; Zeitouni, Michel; Bohbot, Yohann; Stracchi, Valentin; Sroutta-Paillusseau, Sofiane; Jarry, Geneviève; Bodeau, Sandra; Noé, Fabio; Hudelo, Julien; Fournier, Alexandre; Malaquin, Dorothée; Gabrion, Paul; Landemaine, Thomas; Vernier, Agathe; Kubala, Maciej; Leborgne, Laurent; Hermida, Alexis. (2025). Cannabis use among young adults with acute coronary syndrome: impact on initial presentation and long-term prognosis.. Heart (British Cardiac Society). https://doi.org/10.1136/heartjnl-2025-326777
MLA
Martin, Nicolas, et al. "Cannabis use among young adults with acute coronary syndrome: impact on initial presentation and long-term prognosis.." Heart (British Cardiac Society), 2025. https://doi.org/10.1136/heartjnl-2025-326777
RethinkTHC
RethinkTHC Research Database. "Cannabis use among young adults with acute coronary syndrome..." RTHC-07061. Retrieved from https://rethinkthc.com/research/martin-2025-cannabis-use-among-young
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.