Systematic review finds cannabis smoking linked to heart attacks and cardiovascular disease
A systematic review of 85 publications involving over 541,000 subjects found that the large majority of Level I-III studies highlighted increased cardiovascular risk from cannabis use, including acute coronary syndrome.
Quick Facts
What This Study Found
Five Level I systematic reviews, 14 Level II studies (83,961 subjects), and 14 Level III studies (457,495 subjects) were identified. All but five of these highlighted increased cardiovascular risk. In 51 case reports (62 subjects, average age 31), 60% showed ST-elevation, 35% had left anterior descending artery involvement, 34% had cardiomyopathy, and 23% died.
Key Numbers
85 publications, 541,518 subjects. 5 Level I reviews, 14 Level II studies (83,961 subjects), 14 Level III studies (457,495 subjects). Case reports: avg age 31, 60% ST-elevation, 23% died. Only 10% female.
How They Did This
Systematic review of PubMed, Google Scholar, and OpenGrey following PRISMA guidelines. Focused on smoked phytogenic cannabis and acute coronary syndrome. 85 publications covering 541,518 subjects were included.
Why This Research Matters
Cannabis is widely perceived as cardiovascularly benign, but this extensive review shows a consistent signal of increased heart attack risk, particularly in young adults who would not typically be at risk.
The Bigger Picture
Heart attacks in young adults who smoke cannabis may be missed or misattributed. The mechanism likely involves sympathetic activation, vascular inflammation, and platelet activation from cannabis smoke.
What This Study Doesn't Tell Us
No Level I randomized controlled trials specifically address this association. Case reports are inherently biased toward severe outcomes. Most evidence involves smoked cannabis; other forms were excluded.
Questions This Raises
- ?Does vaporized or edible cannabis carry the same cardiovascular risk?
- ?Is the risk dose-dependent?
- ?Would switching from smoked to non-combustion methods reduce cardiac events?
Trust & Context
- Key Stat:
- 23% of case report patients died from cannabis-associated acute coronary syndrome
- Evidence Grade:
- Moderate: large systematic review with extensive literature coverage, though limited by absence of randomized trials.
- Study Age:
- Published in 2019.
- Original Title:
- Cannabis use and acute coronary syndrome.
- Published In:
- Clinical toxicology (Philadelphia, Pa.), 57(10), 831-841 (2019)
- Authors:
- Richards, John R(7), Bing, Mary L, Moulin, Aimee K(2), Elder, Joshua W, Rominski, Robert T, Summers, Phillip J, Laurin, Erik G
- Database ID:
- RTHC-02256
Evidence Hierarchy
Analyzes all available research on a topic using a structured method.
What do these levels mean? →Frequently Asked Questions
Can cannabis cause a heart attack?
This review found a consistent association between cannabis smoking and acute coronary syndrome across multiple study types. The risk appears highest shortly after use and in younger individuals.
Is edible cannabis safer for the heart?
This review specifically excluded non-smoked cannabis, so it cannot answer that question. The combustion-related mechanisms (carboxyhemoglobin, smoke-induced inflammation) would not apply to edibles, but other risks (heart rate elevation) might still be relevant.
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Cite This Study
https://rethinkthc.com/research/RTHC-02256APA
Richards, John R; Bing, Mary L; Moulin, Aimee K; Elder, Joshua W; Rominski, Robert T; Summers, Phillip J; Laurin, Erik G. (2019). Cannabis use and acute coronary syndrome.. Clinical toxicology (Philadelphia, Pa.), 57(10), 831-841. https://doi.org/10.1080/15563650.2019.1601735
MLA
Richards, John R, et al. "Cannabis use and acute coronary syndrome.." Clinical toxicology (Philadelphia, 2019. https://doi.org/10.1080/15563650.2019.1601735
RethinkTHC
RethinkTHC Research Database. "Cannabis use and acute coronary syndrome." RTHC-02256. Retrieved from https://rethinkthc.com/research/richards-2019-cannabis-use-and-acute
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.