August 2025
Meta-analysis finds cannabis use may double the risk of cardiovascular disease death
By Melanie Hinze
A systematic review and meta-analysis of epidemiological studies has found an increased risk of major cardiovascular disease (CVD) events among those who use cannabis, including medicinal cannabis.
Published in Heart, the study reviewed 24 papers, published between 2016 and 2023, including 17 cross-sectional studies, six cohort studies and one case-control study, totalling just over 432 million patients.
Study participants were mostly aged between 19 and 59 years, and in those studies where sex was recorded, cannabis users tended to be mostly male and younger than nonusers.
The estimated increase in risk associated with cannabis use was 1.2 times for stroke, 1.3 times for acute coronary syndrome and 2.1 times for a composite measure of CVD mortality.
Professor Wayne Hall, Emeritus Professor at the National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, said that the analysis found a modest association between self-reported cannabis use and various types of CVD, stroke, MI and a composite measure of CVD mortality.
‘These findings reinforce similar concerns raised by earlier studies which suggested that cannabis use may increase the risk of CVD,’ he said.
Professor Hall said that the average risk in this analysis was modest, but that this might reflect inaccurate measurement of cannabis use (e.g. any cannabis use rather than regular use) and the inclusion of samples with a wide age range, including younger adults.
There was clearly a case for conducting further, more rigorous investigations of the CVD risks associated with cannabis use in light of increased medical cannabis use in Australia and other countries, and the increased legalisation of adult cannabis use in North America and countries in Europe, he said.
‘It is reasonable to expect that the CVD risk of cannabis use would be higher in middle-aged and older adults, who are at increased risk of CVD, especially if they smoke cannabis weekly or more frequently,’ he added.
Professor Hall said the prevalence of this pattern of cannabis use had increased in the USA among older adults where cannabis is used for medical reasons such as to control chronic pain or help with sleep. It also appeared to be the case in Australia.
‘The implications for general practice are that family doctors treating adults for CVD should probably inquire about their use of cannabis for medical or nonmedical reasons,’ Professor Hall said. ‘In the case of those whore port cannabis use, they should discourage its regular use by smoking,’ he added.