Adults with cannabis use disorder found to have 60% higher risk for adverse CVD events

Key takeaways:

• There was a dose-dependent relationship between cannabis use disorder and CVD events.
• However, the study could not causally link CUD to an elevated risk for CVD.

Adults with cannabis use disorder, or CUD, had a significantly higher risk for adverse CVD events compared with those without the disorder, a study published in Addiction found.

“Mounting epidemiological, clinical and laboratory research suggests that regular cannabis use is associated with many adverse health outcomes,” Anees Bahji, a second-year psychiatry resident at Queen’s University in Canada, and colleagues wrote. “Cannabis has been linked to serious [cardiovascular] events, including myocardial infarction, stroke, cardiomyopathies, atherosclerosis and cardiac arrhythmias.”

Despite these links, however, “notable limitations persist, and a consensus on the actual relationship between CUD and CVD remains elusive in the existing literature,” they wrote.

The researchers assessed the relationship between CUD and CVD outcomes in a cohort of Canadian adults. Those with CUD diagnosis codes were matched with participants without the disorder based on gender, birth year and time of presentation — a total of 29,764 pairs, or 59,528 individual participants.

Overall, 2.4% of those with CUD and 1.5% of unexposed participants experienced an incident adverse CVD event (RR = 1.57; 95% CI, 1.4-1.77).

Bahji and colleagues noted that the strength of the association between CUD and CVD was dose dependent, “with larger effect sizes for adverse CVD events with higher CUD severity.” They found RRs were:

• 1.32 (95% CI, 1.22-1.43) for those with one CUD diagnostic code;
• 2.47 (95% CI, 2.28-2.68) for those with two to four CUD diagnostic codes; and
• 2.64 (95% CI, 2.4-2.91) for those with five or more CUD diagnostic codes.

Additionally, RRs for incident CVD were greater for those with no mental health comorbidities or prescription medications and had fewer than five visits to health services in the last 6 months.

The researchers explained that although the study confirmed healthy adults with CUD were at greater risk for CVD, it also “cannot causally attribute the elevated risk to CUD.”

However, they noted that the 60% increased risk for CVD associated with CUD “suggests potential value in using CUD as a basis for targeting preventive interventions, as occurs with other risk factors.”

“This might include increased testing, screening or surveillance for CVD in CUD populations,” they wrote. “Additional research is needed to clarify the underlying mechanisms and to guide specific preventive strategies. If a causal mechanism is confirmed, the treatment of CUD may have preventive benefits for cardiovascular health.”

Bahji and colleagues ultimately concluded that the findings underscore “the importance of educating our patients about the potential risks associated with cannabis use and CUD.”