Studies Show Association Between Regular Cannabis Use, Heart Failure

Regular usage of cannabis may increase the risk of heart failure (HF), stroke, or heart attack, even after adjusting for other cardiovascular disease (CVD) risk factors, including type 2 diabetes, high blood pressure, and obesity, according to 2 preliminary studies that will be presented at the American Heart Association (AHA) 2023 Scientific Sessions. The Scientific Sessions will be held from November 11 through 13, 2023, in Philadelphia, Pennsylvania.¹

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“Prior research shows links between marijuana use and [CVD] like coronary artery disease, [HF], and atrial fibrillation, which is known to cause [HF],” Yakubu Bene-Alhasan, MD, MPH, a resident physician at Medstar Health in Baltimore, Maryland, said in a press release. “Marijuana use isn’t without its health concerns, and our study provides more data linking its use to cardiovascular conditions.”¹

In a 2023 study published in JAMA Network Open, cannabis use disorder (CUD) was common among those who used cannabis in a state with legal recreational cannabis use. The prevalence of CUD was 21.3% and the prevalence of moderate to severe CUD was 6.5%, with 7.2% for those who used cannabis for nonmedical use.² The study authors also emphasized that the use of cannabis is increasing in the United States, with 38 states having legalized medical cannabis use and 23 with legalized recreational use as of June 2023.²

In the first poster abstract at the AHA Scientific Sessions 2023, investigators included more than 150,000 individuals in the United States to determine the association between daily marijuana use and HF. No participants had HF at the time of enrollment in the study. They completed a survey about the frequency of their marijuana use and were followed for 45 months. The individuals used marijuana recreationally, or if used for medical reasons, used marijuana beyond the medical purposes.¹

The investigators found that 2958 individuals developed HF during the study period. Those who reported marijuana use had a 34% increase of developing HF compared to those who never smoked marijuana, according to the statement. Furthermore, when coronary artery disease was added to the study, the risk of HF dropped from 34% to 27%, which investigators believe suggested that it is a pathway of daily marijuana use leading to HF.¹

However, it is important to note that the study did not include data on how the marijuana was consumed, which could influence CVD outcomes, according to the investigators.¹

In the second study that will be presented at AHA’s Scientific Sessions, investigators used data from the 2019 National Inpatient Sample to determine if hospital stays for CVD events was complicated by those who used marijuana.¹

“Since 2015, cannabis use in the United States has almost doubled, and it is increasing in older adults. Therefore, understanding the potential increased [CVD] risk from cannabis use is important,” Avilash Mondal, MD, a resident physician at Nazareth Hospital in Philadelphia, Pennsylvania, said in the statement. “What is unique about our study is that patients who were using tobacco were excluded because cannabis and tobacco are sometimes used together. Therefore, we were able to specifically examine cannabis use and [CVD] outcomes.”¹

The study authors used records for 28,535 adults older than 65 years with CVD risk factors who did not report tobacco usage and used cannabis. In the study, the individuals who used marijuana included a hospital code for CUD. For those with existing CVD risk factors, 20% of individuals had an increased risk of major heart or brain events when hospitalized compared to those who did not use cannabis.¹

Additionally, 13.9% of those who used cannabis with CVD risk factors had a major adverse heart and brain event when hospitalized compared to those who did not use cannabis. Cannabis users had a higher rate of heart attack at 7.6% compared to 6% for those who did not use cannabis and were more likely to be transferred to another facility at 28.9% and 19%, respectively.¹

Investigators also found that high blood pressure and high cholesterol were predictors of major adverse heart and brain events for those who used cannabis. One limitation of the study included coding errors in the patient’s records, because CUD codes could vary from hospital to hospital.¹

“We must be mindful about major heart and stroke events in older adults with [CUD]. At this point, we need more studies to understand the long-term effects of cannabis use,” Mondal said in the press release. “Health care professionals should include the question, ‘are you using cannabis?’ when taking a patient’s history. If you ask patients if they are smoking, [they] think cigarette smoking. The main public message is to be more aware of the increased risks and open the lines of communication so that cannabis use is acknowledged and considered.”¹

Reference

1. Marijuana use linked with increased risk of heart attack, heart failure. News release. American Heart Association. November 6, 2023. Accessed November 7, 2023. https://newsroom.heart.org/news/marijuana-use-linked-with-increased-risk-of-heart-attack-heart-failure
2. Lapham GT, Matson TE, Bobb JF, Luce C, et al. Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US State Where Recreational Cannabis Use Is Legal. JAMA Netw Open. 2023;6(8):e2328934. doi:10.1001/jamanetworkopen.2023.28934