In a national sample of nearly 437,000 US adults, both daily and non-daily cannabis use were associated with increased odds of stroke, and daily use was also linked to other cardiovascular outcomes.
Cardiologists assessing patient risk factors, cannabis users concerned about heart health, public health researchers tracking population-level cardiovascular trends.
What the researchers found
Analyzing data from 436,949 adults surveyed in the Behavioral Risk Factor Surveillance System (BRFSS) between 2020 and 2023, researchers found dose-dependent associations between cannabis use and cardiovascular outcomes.
Non-daily cannabis use (compared to no past-30-day use) was associated with increased odds of stroke (adjusted OR = 1.28) and a composite cardiovascular outcome measure (aOR = 1.16). Daily cannabis use showed even stronger associations, linked to increased odds of stroke and additional cardiovascular endpoints.
The weighted prevalence of cardiovascular conditions in the sample was: coronary heart disease 4.4%, myocardial infarction 4.5%, stroke 3.6%, and any cardiovascular outcome 9.3%.
The study also examined whether these associations varied by age and sex, finding potential heterogeneous effects — suggesting that cannabis's cardiovascular risk may not be uniform across the population.
Importantly, the models adjusted for sociodemographics, health status, other substance use, and state-level cannabis laws, with state and year fixed effects to control for unmeasured state characteristics and temporal trends.
Why it matters
This is one of the largest studies to date of cannabis and cardiovascular outcomes, using a national surveillance system that captures a representative US population. The stroke association — present even at non-daily use levels — is particularly concerning because stroke risk factors are important public health targets. The dose-response pattern (stronger associations with daily use) strengthens the plausibility of a causal relationship.
The numbers in context
436,949 adults, 2020–2023. Non-daily use: stroke aOR = 1.28 (95% CI: 1.06–1.54), composite aOR = 1.16 (95% CI: 1.03–1.29). Daily use: higher odds for stroke and additional outcomes. Cardiovascular prevalence: CHD 4.4%, MI 4.5%, stroke 3.6%, any CV outcome 9.3%.
How the study worked
Cross-sectional study using BRFSS national survey data from 436,949 adults (2020–2023). Multivariable logistic regression with adjustment for sociodemographics, health status, substance use, and state cannabis laws. State and year fixed effects included. Outcomes: coronary heart disease, myocardial infarction, stroke, and composite cardiovascular measure.
Who was studied
N=436,949 adults aged 18 and older, 50% female, U.S. national survey from 2020-2023.
What this study cannot tell us
Cross-sectional design cannot establish causation. Self-reported cannabis use likely underestimates actual use. Cannot determine method of consumption (smoking vs. edibles vs. vaping), which may differentially affect cardiovascular risk. Residual confounding from unmeasured factors is possible despite extensive adjustment. The BRFSS surveys non-institutionalized adults, missing some high-risk populations.
How to read the evidence
Large national cross-sectional study with extensive statistical controls — provides strong associational evidence but cannot establish that cannabis use causes cardiovascular events.
When this study was published
Published in 2026 with data from 2020–2023, capturing the most recent national data on cannabis-cardiovascular associations in a post-legalization landscape.
The bigger picture
This national data adds to the cardiovascular evidence in this database: the cocaine-cannabis comparison (RTHC-00273), the cardiac surgery study (RTHC-00237), and the JAMA therapeutic review noting cardiovascular concerns (RTHC-00250). The dose-response pattern and stroke specificity provide the most detailed population-level picture yet of cannabis-cardiovascular associations. The older driver review (RTHC-00266) raised concerns about amplified cannabis effects in aging cardiovascular systems — this study provides the epidemiological data to support that concern.
Replication
Not stated in abstract.
Funding
Not reported in abstract.
Conflicts of interest
Not reported in abstract.
Questions still open
- Does the method of cannabis consumption (smoking vs. non-smoking) drive the cardiovascular associations? Are the age and sex differences in cardiovascular risk clinically actionable for screening? Would longitudinal data confirm the cross-sectional associations seen here?
Read the original research
The association between cannabis use and cardiovascular outcomes among U.S. Adults, 2020-2023.
Addictive behaviors, 172, 108529
Addictive Behaviors is a well-regarded journal focusing on research related to addiction and substance use.
Citation
Sun, Ruoyan; Judd, Suzanne E; De, Prabal K. (2026). The association between cannabis use and cardiovascular outcomes among U.S. Adults, 2020-2023.. Addictive behaviors, 172, 108529. https://doi.org/10.1016/j.addbeh.2025.108529
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