Regular cannabis use was linked to greater cardiovascular risks, especially in people who did not also smoke tobacco
In an analysis of electronic health records, regular cannabis use was associated with higher rates of stroke, arrhythmia, and death, with the strongest associations found in cannabis users who did not also use tobacco.
Quick Facts
What This Study Found
In the total sample and non-tobacco subgroup, regular cannabis use was significantly associated with greater risk for stroke (CVA), arrhythmia, subarachnoid hemorrhage (SAH), and all-cause mortality. Among tobacco users, cannabis was only associated with greater risk for arrhythmia and SAH. Tobacco users had the highest overall cardiovascular disease prevalence regardless of cannabis status.
Key Numbers
8,944 cannabis users matched to controls. 4,682 with tobacco use disorder, 4,262 without. Non-tobacco cannabis users: significant associations with CVA, arrhythmia, SAH, and mortality. Tobacco-using cannabis users: significant for arrhythmia and SAH only.
How They Did This
Retrospective analysis of electronic health records via IBM Watson Health Explorys. 8,944 cannabis-using patients matched to controls using propensity scores on demographics, zip code income, BMI, and tobacco status. Subgroup analyses for tobacco users (n=4,682) and non-tobacco users (n=4,262).
Why This Research Matters
The finding that cannabis cardiovascular risks are more apparent in non-tobacco users suggests cannabis is an independent cardiovascular risk factor whose effects may be masked in tobacco users by their already-elevated baseline risk.
The Bigger Picture
As cannabis use increases and tobacco use declines, the cardiovascular effects of cannabis may become more clinically visible. This study suggests that cannabis-only users may need cardiovascular screening that has traditionally been reserved for tobacco smokers.
What This Study Doesn't Tell Us
Retrospective EHR data from a single health system (Cleveland). Cannabis use identified by diagnosis codes and drug screens, which may undercount casual users. Cannot establish causation. Unmeasured confounders possible despite matching.
Questions This Raises
- ?What mechanisms drive cannabis-associated cardiovascular risk?
- ?Does the route of cannabis administration (smoking vs. edibles) affect cardiovascular outcomes?
- ?Would prospective studies with controlled exposure confirm these associations?
Trust & Context
- Key Stat:
- Cannabis cardiovascular risks strongest in non-tobacco users
- Evidence Grade:
- Large matched-cohort EHR study with propensity scoring, but retrospective design and potential unmeasured confounders.
- Study Age:
- 2020 study. Important early evidence on cannabis-specific cardiovascular risk independent of tobacco.
- Original Title:
- The association between regular cannabis use, with and without tobacco co-use, and adverse cardiovascular outcomes: cannabis may have a greater impact in non-tobacco smokers.
- Published In:
- The American journal of drug and alcohol abuse, 46(4), 454-461 (2020)
- Authors:
- Winhusen, Theresa(2), Theobald, Jeff(2), Kaelber, David C(4), Lewis, Daniel
- Database ID:
- RTHC-02918
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked Questions
Why were risks higher in non-tobacco users?
Tobacco users already have very high cardiovascular disease rates, so the additional risk from cannabis may be harder to detect statistically. In non-tobacco users, the cannabis-associated risk stood out more clearly against a lower baseline.
Does this mean cannabis causes heart problems?
This observational study found associations but cannot prove causation. However, the associations persisted after matching on multiple factors, suggesting cannabis may be an independent cardiovascular risk factor.
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Cite This Study
https://rethinkthc.com/research/RTHC-02918APA
Winhusen, Theresa; Theobald, Jeff; Kaelber, David C; Lewis, Daniel. (2020). The association between regular cannabis use, with and without tobacco co-use, and adverse cardiovascular outcomes: cannabis may have a greater impact in non-tobacco smokers.. The American journal of drug and alcohol abuse, 46(4), 454-461. https://doi.org/10.1080/00952990.2019.1676433
MLA
Winhusen, Theresa, et al. "The association between regular cannabis use, with and without tobacco co-use, and adverse cardiovascular outcomes: cannabis may have a greater impact in non-tobacco smokers.." The American journal of drug and alcohol abuse, 2020. https://doi.org/10.1080/00952990.2019.1676433
RethinkTHC
RethinkTHC Research Database. "The association between regular cannabis use, with and witho..." RTHC-02918. Retrieved from https://rethinkthc.com/research/winhusen-2020-the-association-between-regular
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.