Meta-Analysis Affirms Cannabis Use Poses Significant Cardiovascular Risk
Despite evolving drug laws and changing user habits, a recent comprehensive meta-analysis reinforces a clear connection between cannabis consumption and serious adverse cardiovascular events (MACE). The findings suggest that as cannabis becomes more widely available and accepted, healthcare providers should remain vigilant about its potential impact on heart health.
This updated analysis, drawing on two dozen pharmacoepidemiological studies published between 2016 and 2023, found elevated cardiovascular risks among individuals who reported using cannabis at some point (“ever-users”) and those detected through drug screens.
“These findings underscore the importance of investigating cannabis use in all patients presenting with serious cardiovascular disorders,” stated lead researcher Emilie Jouanjus, PharmD, PhD, of the University of Toulouse in France, and her colleagues in their report published in Heart.
Risk Holds Strong in a Changing Landscape
The current study builds upon a previous meta-analysis by Jouanjus’ team, which used data up to 2016 and also identified a correlation between cannabis exposure and increased cardiovascular disease (CVD). The significance of this new research lies in its confirmation of these risks within a contemporary context. The period covered (2016-2023) saw widespread changes in cannabis’s legal status, both for medical and recreational purposes, across many regions.
“The legalization of the drug and the expansion of its medical use worldwide have likely altered general perceptions of cannabis and contributed to an overall rise in consumption,” the researchers noted. They highlighted that user profiles and consumption patterns today differ significantly from those a decade ago, particularly with a notable trend towards cannabis products exhibiting increasing potency, specifically higher concentrations of delta-9-tetrahydrocannabinol (THC).
Growing Concerns Over Increased Potency
Public health experts Stanton Glantz, PhD, and Lynn Silver, MD, MPH, from the University of California San Francisco, echoed these concerns in an accompanying editorial. They pointed out that the cannabis available today is even more potent than the data captured in the latest meta-analysis (which used data up to 2018) might fully reflect.
“The use of higher potency products is associated in turn with increased frequent and problem use,” they wrote. They emphasized that further research is needed to clarify how these changes specifically affect cardiovascular risk and to determine the extent to which the risk is attributable to cannabinoids themselves versus other components like particulate matter or terpenes.
Screening for Cannabis Use: A Public Health Imperative
Both the study authors and the editorialists advocate for increased awareness and screening regarding cannabis use in clinical settings. Jouanjus’ group recommended screening patients with serious cardiovascular disorders. Glantz and Silver went further, proposing that cannabis use should be assessed in all patients, just like tobacco and alcohol use.
“At least in the USA, health professionals are the most influential source of cannabis information regardless of patient age, cannabis use, or state legal status,” the editorialists stated, stressing the importance of clinicians asking about use, educating patients about risks, and incorporating cannabis use into clinical decision-making.
They concluded with a strong call for public health measures, asserting that cardiovascular and other health risks must be central to the regulation of cannabis products and marketing. “Specifically, cannabis should be treated like tobacco: not criminalized but discouraged, with protection of bystanders from secondhand exposure.”
Understanding the Study Data
The meta-analysis synthesized findings from 24 studies, including cross-sectional studies, cohort studies, and one case-control study. The studies involved participants with a mean age ranging from 19 to 59 years, primarily male cannabis users. A sensitivity analysis focusing only on cohort studies validated the main results.
Study Limitations Highlight Need for Better Data
The researchers acknowledged certain limitations within the included studies. Several reports used data from the same source, potentially leading to some overlap in patient populations. More significantly, the reliability and detail of reported cannabis exposure varied considerably across studies.
As Glantz and Silver observed, most studies simply measured “current,” “past 30-day,” “past year,” or “ever” use, or relied on a positive drug test without specifying crucial details like the mode of administration, product potency, or intensity of use. This lack of detail, particularly regarding frequency and potency, may have led to an underestimation of the true cardiovascular risk, as individuals classified as users might include light or intermittent consumers.
