In a matched comparison of nearly 250,000 patients per group, cocaine users had significantly higher rates of cardiac arrhythmias, heart attacks, strokes, and death compared to cannabis users.
Cardiologists assessing substance-related cardiac risk, emergency physicians evaluating substance-using patients, public health researchers comparing substance harm profiles.
What the researchers found
Using the TriNetX database, researchers compared cardiovascular outcomes between cocaine users and cannabis users after propensity score matching to reduce baseline differences. Each cohort included 248,769 patients.
The primary outcome — new-onset cardiac arrhythmia — was significantly higher in cocaine users compared to cannabis users. Secondary outcomes showed the same pattern: cocaine users had higher rates of cardiac arrest events, major adverse cardiovascular events (myocardial infarction and stroke), and all-cause mortality.
The study contextualized these findings within prevalence data: cannabis use disorder is considerably more prevalent than cocaine use disorder (14.7% vs. 2.2% for individuals aged 12 and older), meaning the total cardiovascular burden from each substance depends on both the per-user risk and the size of the user population.
Why it matters
While cocaine's cardiotoxicity is well-established, this study provides a direct, matched comparison with cannabis — useful because both substances are commonly used and both have cardiovascular effects. The finding that cannabis users had significantly lower rates of arrhythmias and other cardiac events than matched cocaine users provides relative risk context, though it doesn't establish that cannabis is safe for the heart.
The numbers in context
248,769 patients per matched cohort. Cannabis use disorder prevalence: 14.7%. Cocaine use disorder prevalence: 2.2% (6.2% in ages 18–25). Cocaine users had higher rates of: new-onset arrhythmia, cardiac arrest, MI, stroke, and all-cause mortality compared to cannabis users.
How the study worked
Retrospective cohort study using the TriNetX database. Created two cohorts: cocaine users and cannabis users. Propensity score matching yielded 248,769 patients per group. Primary outcome: new-onset cardiac arrhythmia. Secondary outcomes: cardiac arrest, major adverse cardiovascular events (MI, stroke), all-cause mortality.
Who was studied
N=248,769 cocaine users and N=248,769 cannabis users, matched cohorts from TriNetX database.
What this study cannot tell us
Retrospective database study relying on diagnostic codes — may undercount both cocaine and cannabis use. The comparison is between two illicit/semi-legal substances, not against non-users. Propensity score matching cannot eliminate all confounding. Polysubstance use (common in both groups) could influence outcomes. The study period and database may not represent all populations.
How to read the evidence
Large retrospective cohort study with propensity score matching — strong statistical power but limited by database coding accuracy and inability to control all confounders.
When this study was published
Published in 2026, providing a contemporary matched comparison of cardiovascular outcomes between the two most commonly used illicit substances.
The bigger picture
This adds comparative cardiovascular data to the cardiac surgery study (RTHC-00237), which found CUD didn't worsen surgical outcomes, and the broader cardiovascular evidence (RTHC-00167, RTHC-00178). The JAMA therapeutic review (RTHC-00250) noted emerging cardiovascular concerns with cannabis. This study suggests cannabis's cardiovascular risk profile, while not zero, is substantially lower than cocaine's — important context for both clinical risk assessment and public health messaging.
Replication
Not stated in abstract.
Funding
Not reported in abstract.
Conflicts of interest
Not reported in abstract.
Questions still open
- What specific arrhythmia types differ between cocaine and cannabis users? Does the method of cannabis consumption (smoking vs. edibles) affect cardiovascular risk? Would a three-way comparison adding a non-user control group change the interpretation?
Read the original research
Incidence of New-Onset Cardiac Arrhythmias in Cocaine and Cannabis Users: A Retrospective Cohort Study.
European heart journal. Acute cardiovascular care
The European Heart Journal: Acute Cardiovascular Care is a reputable journal focusing on cardiovascular health.
Citation
Rhabneh, Laith; Ababneh, Ra'ed; Qaddour, Shahd; Alwardat, Abdel Rahman; Aloqaily, Mohammed; Hazaimeh, Khalid; Awad, Ali. (2026). Incidence of New-Onset Cardiac Arrhythmias in Cocaine and Cannabis Users: A Retrospective Cohort Study.. European heart journal. Acute cardiovascular care. https://doi.org/10.1093/ehjacc/zuag011
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