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

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).

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.

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.

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.

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.