Cannabis Use May Double Risk of Death From Cardiovascular Disease, Study Finds
A new scientific analysis indicates that cannabis use may increase the risk of cardiovascular health issues, including stroke.
In an accompanying editorial, two health experts say these risks are serious enough to warrant the regulation of cannabis in the same manner as tobacco.
Previous research has reported on the health benefits of cannabis for people with chronic pain and other ailments, but experts say the potential effects of cannabis should be discussed with your doctor.
Medical experts are sending out another strong warning about cannabis use and the risk of cardiovascular health issues.
In an analysis published in the journal Heart, researchers report heightened risks of stroke, acute coronary syndrome, and death from cardiovascular disease associated with frequent cannabis use.
In an accompanying editorial, two health experts say the dangers from cannabis use are serious enough to warrant the substance being regulated much like tobacco.
The editorial authors say the warnings are particularly important because the recent widespread legalization of the drug may have convinced many people that cannabis use is safe.
'Frequent cannabis use has increased in several countries, and many users believe that it is a safe and natural way to relieve pain or stress. In contrast, a growing body of evidence links cannabis use to significant harms throughout life, including cardiovascular health of adults,' wrote Stanton Glantz, PhD, an emeritus professor at the University of California San Francisco, and Lynn Silver, MD, a professor in UCSF's Department of Epidemiology and a program director at the Public Health Institute in Oakland, CA.
'Specifically, cannabis should be treated like tobacco: not criminalized but discouraged, with protection of bystanders from secondhand exposure,' the editorial authors added.
Robert Page II, PharmD, a professor in the Department of Clinical Pharmacy and the Department of Physical Medicine/Rehabilitation at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, noted the analysis relied on observational studies, but said the message is clear.
'This meta-analysis validates current large observation studies that cannabis should be considered a potential risk factor for premature development of ASCVD (atherosclerotic cardiovascular disease), said Page, who was chair of an American Heart Association writing group that authored a 2020 report on cannabis, medical cannabis, and heart health. Page wasn't involved in the present study.
'If we ignore these signals, we are destined to repeat the fatal history of cigarette smoking, which took years to finally realize its devastating effects on cardiovascular health and mortality,' he told Healthline.
Cannabis and heart health
In their analysis, researchers looked at 24 studies published between January 2016 and January 2023 that included about 200 million people.
The study participants were mostly between the ages of 19 and 59. Cannabis use tended to be more frequent in males and in younger people.
The researchers said their analysis of that data revealed that cannabis use doubled the risk of dying from cardiovascular disease.
They also reported that people who used cannabis had a 29% higher risk of acute coronary syndrome, a condition that causes sudden reduced or blocked blood flow to the heart, as well as a 20% higher risk of stroke.
The researchers acknowledged that many of the studies they analyzed lacked information on missing data and had imprecise measures of cannabis exposure. Most of the studies were also observational.
Nonetheless, their analysis comes less than a month after another study concluded that chronic use of cannabis is associated with a higher risk of endothelial dysfunction, a type of non-obstructive coronary artery disease in which there are no heart artery blockages but the large blood vessels on the heart's surface constrict instead of dilating.
In addition, another analysis from earlier this year reported that cannabis users were six times more likely to have a heart attack than non-users. A 2024 study concluded that people who use cannabis to treat chronic pain had a higher risk of atrial fibrillation and other forms of heart arrhythmia.
The researchers in the new analysis say their findings are particularly important because the use of cannabis has soared in recent years. They also note that the potency of the drug has increased.
There was no delineation in the analysis, however, on the risks of smoking cannabis compared to ingesting it.
Cheng-Han Chen, MD, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California, said both methods may present health risks. Chen wasn't involved in the study.
'It is thought that ingesting THC increases systolic absorption of the chemical when compared to smoking THC and thus results in greater adverse effects,' he told Healthline. 'However, cannabis smoke comes with a separate set of health concerns, as the smoke contains many carcinogens and mutagens similar to tobacco smoke.'
Ziva Cooper, the director of the UCLA Center for Cannabis and Cannabinoids, said the frequency someone uses cannabis, as well as the dosage, are also important factors. Cooper was likewise not involved in the study.
She noted that new research is starting to show there are mental health risks to frequent cannabis use. One of those is cannabis use disorder, a condition that is estimated to affect 30% of people who use the substance.
'There are new risks that are emerging that weren't even on the radar,' Cooper told Healthline.
She added cannabis can also impair people's ability to drive as well as impair their cognitive abilities.
'These are things that can affect a person's everyday life,' Cooper said.
Defending cannabis use
Paul Armentano, the deputy director of NORML, a non-profit that advocates for the responsible use of cannabis, acknowledges there are studies that report health risks associated with cannabis use. Armentano wasn't involved in the study.
However, he told Healthline there are others who conclude there is no risk or even a decreased risk of cardiovascular disease from cannabis use. These include a 2023 study, a 2020 study, and a 2023 meta-analysis.
'In short, while tobacco smoke exposure's role in cardiovascular disease is well established, the potential role of cannabis smoke is not,' Armentano said.
'Nonetheless, persons wishing to mitigate their intake of cannabis smoke can do so via the use of herbal vaporizers, which heat cannabinoids to the point of activation but below the point of combustion.'
Armentano cited studies in 2006 and 2007 that reported no health effects from vaporization.
Some research has reported on some overall health benefits derived from cannabis use.
A 2023 study concluded that medical cannabis can improve the quality of life for some people with chronic pain.
Other research has reported that cannabis can be helpful to people with depression, social anxiety, and post-traumatic stress disorder (PTSD).
There are also indications that cannabis products can help ease the side effects of cancer treatments.
Talking with your doctor about cannabis
In their editorial, Glantz and Silver encourage medical professionals to become leaders in cannabis education.
'There is an important role for public health and public policy in addressing the risks identified [in the new analysis],' they wrote. 'While the trend toward legalization is established, that does not mean that the risks of cannabis use should be minimized or its use encouraged.'
Page said he takes cannabis use into consideration when assessing his patients' cardiovascular health.
'While many of the current cardiovascular risk calculators do not include smoking cannabis into their algorithms, I do include it (just like smoking cigarettes) when assessing patients' cardiovascular risk and consider it just as powerful a risk factor as smoking cigarettes,' he said.
Page added that people should be informed about the many potential health issues of cannabis use before deciding whether to use it.
'Know the risks and talk to your primary care provider before considering any use, medical or recreational. Many younger adults feel invincible and have the belief that 'This will not happen to me' or 'I could never develop cannabis use disorder.' However, it does and can occur,' he said.
'For older adults, I caution them regarding potential drug-drug interactions as both THC [tetrahydrocannabinol] and CBD [cannabidiol] can have effects on a large majority of medications, both pharmacokinetically and pharmacodynamically,' Page added.
Chen agrees that patients need to educate themselves about cannabis before trying it.
'Any form of cannabis use does involve some risk to your health. Everyone must decide for themselves how much risk they want to expose themselves to,' said Chen.
'I would advise people to avoid smoking cannabis, as the smoke can directly harm the lungs. Also, patients with known pre-existing cardiovascular disease or with cardiovascular risk factors should consider avoiding cannabis use in general, given the potential harm to heart health,' he added.
Cooper noted that cannabis has 500 different chemical components, so its effects can vary greatly from person to person.
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