Recreational drug use, including cannabis, nearly tripled the risk of major cardiovascular events within one year of cardiac hospitalization | Research

The takeaway

Among 1,392 patients admitted to intensive cardiac care units across France, those who tested positive for recreational drugs (including cannabis) had nearly three times the risk of major cardiovascular events at one year.

Cardiologists, cardiac rehabilitation providers, cannabis consumers with heart disease risk factors

Adjusted HR 2.91 for major cardiovascular events among drug-positive cardiac patients

What the researchers found

Recreational drug users had higher one-year MACCE (major adverse cardiovascular and cerebrovascular events) rates than non-users (12.7% vs. 6.0%). Cannabis use alone was associated with increased MACCE risk (HR 1.77, 95% CI 1.02-3.08). After adjusting for traditional prognostic factors, any recreational drug use remained independently associated with MACCE (adjusted HR 2.91, 95% CI 1.68-5.05).

Why it matters

This is one of the first prospective studies with systematic drug testing to show that recreational drug use, including cannabis specifically, independently predicts major cardiovascular events after cardiac hospitalization. The nearly threefold adjusted risk is clinically meaningful.

The numbers in context

1,392 patients (mean age 63, 69.9% men). 157 (11.3%) tested positive for any drug. 94 (6.7%) experienced MACCE at one year. Cannabis: HR 1.77 (95% CI 1.02-3.08). Opioids: HR 3.60 (95% CI 1.57-8.23). Any drug use adjusted HR: 2.91 (95% CI 1.68-5.05).

How the study worked

ADDICT-ICCU study: prospective multicentric study across 39 French intensive cardiac care units in April 2021. All consecutive admissions were included. Systematic urine drug testing screened for cannabis, opioids, cocaine, amphetamines, and MDMA. Primary outcome was one-year MACCE (cardiovascular death, nonfatal MI, or stroke). Multivariable Cox regression adjusted for traditional prognostic factors.

What this study cannot tell us

Short enrollment window (2 weeks in April 2021). French population may not generalize globally. Urine testing identifies recent use but not chronic patterns. Cannabis and opioid categories were grouped with respective drug classes. Residual confounding possible.

How to read the evidence

Prospective multicentric design with systematic drug testing and one-year follow-up provides strong methodology, though the single enrollment window and moderate sample of drug users limit precision.

When this study was published

2026 publication using April 2021 enrollment data with one-year follow-up

The bigger picture

Cardiovascular disease is the leading cause of death globally. If cannabis use independently increases the risk of repeat cardiac events, this has implications for how cardiologists counsel patients, especially as cannabis becomes more normalized.

Questions still open

What is the mechanism by which cannabis increases cardiovascular event risk? Is the risk dose-dependent? Would cessation after cardiac admission reduce the risk?

Common questions

Was cannabis specifically linked to heart problems?

Yes. Cannabis use alone was associated with a 77% increased risk of major cardiovascular events at one year (HR 1.77), and this was a specific finding separate from other drugs.

How were drugs detected?

Systematic urine drug testing was performed on all patients admitted to the cardiac ICU, regardless of the reason for admission, removing selection bias in who gets tested.

Read the original research

Association Between Recreational Drug Use and Cardiovascular Events Post-Hospitalization in France.

Circulation. Population health and outcomes, 19(2), e011905

View on PubMed ↗Publisher’s paper ↗

Citation

Mirailles, Raphael; Delmas, Clément; Toupin, Solenn; Bouleti, Claire; Trimaille, Antonin; Schurtz, Guillaume; Piliero, Nicolas; Andrieu, Stéphane; Lattuca, Benoît; Rossanaly Vasram, Reza; Lim, Pascal; Noirclerc, Nathalie; Goralski, Marc; Deney, Antoine; Roubille, François; Fauvel, Charles; Bochaton, Thomas; Boccara, Franck; Gerbaud, Edouard; Puymirat, Etienne; Vicaut, Eric; Dillinger, Jean-Guillaume; Henry, Patrick; Pezel, Theo. (2026). Association Between Recreational Drug Use and Cardiovascular Events Post-Hospitalization in France.. Circulation. Population health and outcomes, 19(2), e011905. https://doi.org/10.1161/CIRCOUTCOMES.124.011905