Cannabis Users Hospitalized with Fatty Liver Disease Had Lower Mortality but Higher Heart Attack and Stroke Risk | Research

The takeaway

Among 3.4 million patients hospitalized with fatty liver disease, cannabis users had 30% lower in-hospital mortality and less cirrhosis, but 42% higher odds of heart attack and 53% higher odds of stroke.

People with fatty liver disease who use cannabis, hepatology researchers, clinicians managing patients with metabolic liver disease

30% lower mortality but 42% higher MI risk in cannabis-using liver disease patients

What the researchers found

After adjusting for confounders, cannabis use among MASLD patients was associated with lower odds of in-hospital mortality (aOR 0.70), cirrhosis (aOR 0.72), decompensated cirrhosis (aOR 0.73), chronic kidney disease (aOR 0.81), and hepatocellular carcinoma (aOR 0.71). However, cannabis use was associated with higher odds of myocardial infarction (aOR 1.42) and stroke (aOR 1.53).

Why it matters

This large database study suggests cannabis may have contrasting effects in liver disease patients: potentially protective for liver-related outcomes but potentially harmful for cardiovascular outcomes. The findings align with pre-clinical evidence for CBD's anti-inflammatory and antifibrotic effects on the liver.

The numbers in context

N=3,379,484 MASLD patients, 52,315 (1.54%) cannabis users. Lower odds with cannabis use: mortality aOR 0.70 (p<0.001), cirrhosis aOR 0.72 (p<0.001), decompensated cirrhosis aOR 0.73 (p<0.001), CKD aOR 0.81 (p<0.001), HCC aOR 0.71 (p=0.003). Higher odds: MI aOR 1.42 (p<0.001), stroke aOR 1.53 (p<0.001).

How the study worked

Retrospective analysis of the National Inpatient Sample (NIS) database from 2016-2020, identifying 3,379,484 adult patients hospitalized with metabolic dysfunction-associated steatotic liver disease (MASLD), comparing outcomes between 52,315 cannabis users (1.54%) and nonusers.

What this study cannot tell us

Administrative database study relying on ICD codes, which may undercount cannabis use and misclassify outcomes. Cannot determine dose, frequency, or type of cannabis used. Observational design cannot establish causation. Cannabis users differed from nonusers in age and other characteristics.

How to read the evidence

Moderate evidence from a very large national database, though limited by the observational design and reliance on billing codes for cannabis use identification.

When this study was published

2025 study analyzing U.S. hospital data from 2016-2020.

The bigger picture

The dual nature of these findings reflects the complexity of cannabinoid pharmacology. While cannabinoid receptors in the liver may mediate anti-inflammatory and antifibrotic effects, the cardiovascular risks associated with cannabis use appear to persist even in populations where liver outcomes are favorable.

Questions still open

Is the liver-protective association driven by CBD specifically, or by other cannabinoids? Would isolated CBD show the same cardiovascular risks? Could the liver benefits be leveraged while managing cardiovascular risk?

Common questions

Does cannabis protect the liver?

This study found associations between cannabis use and lower rates of cirrhosis, liver cancer, and in-hospital death among fatty liver disease patients. However, the observational design cannot prove cannabis caused these better outcomes, and the cardiovascular risks found in the same study add complexity.

Why might cannabis have opposite effects on liver and heart?

Pre-clinical research suggests cannabinoids, particularly CBD, have anti-inflammatory and antifibrotic effects in liver tissue. The cardiovascular risks may be mediated through different pathways, including effects on heart rate, blood pressure, and blood vessel function.

Read the original research

Cannabis Use in Metabolic Dysfunction-Associated Steatotic Liver Disease: Friend or Foe? A Retrospective Analysis.

Journal of clinical gastroenterology

View on PubMed ↗Publisher’s paper ↗

Citation

Paladiya, Ruchir; Singh, Anmol; Changela, Madhav; Shah, Mihir; Singh, Carol; Kumar, Vikash; Sohal, Aalam; Doshi, Shreyans; Parikh, Neil. (2025). Cannabis Use in Metabolic Dysfunction-Associated Steatotic Liver Disease: Friend or Foe? A Retrospective Analysis.. Journal of clinical gastroenterology. https://doi.org/10.1097/MCG.0000000000002321