With the spread of marijuana legalization and perceptions changing, increasing evidence suggests the health risks of flying under radar: the heart.
New systematic reviews and meta-analysis of real-world data found that people who use marijuana face higher risk of adverse cardiovascular events, including stroke, heart attack, and cardiovascular death. These discoveries are at a critical moment due to legal entertainment in parts of Europe and are widely accepted in North America.
Analyze millions to understand risks
The researchers reviewed 24 studies involving more than 432 million patients in various populations. They found that marijuana use is with:
- The risk of acute coronary syndrome is 29% higher (RR = 1.29)
- Stroke risk increased by 20% (RR = 1.20)
- More than twice the risk of cardiovascular death (RR = 2.10)
The study focused on major cardiovascular events (MACE), a clinical category that includes nonfatal heart attacks, strokes, and heart-related cause death.
Why do these effects occur?
This study explores several possible biological explanations. Cannabinoids such as THC and CBD act on CB1 and CB2 receptors that affect the cardiovascular system in complex ways. Activation of CB1 receptors is associated with oxidative stress, inflammation and vascular dysfunction. As the authors point out, “CB1 activation in the cardiovascular system is associated with oxidative stress, tissue damage, cell death, proarthropathic pain, fibrosis, fibrosis, proinflammatory effects.”
Meanwhile, high-power cannabis products with elevated THC levels are more common than they were a decade ago. These may exacerbate effects such as vasoconstriction – stenosis of blood vessels – which in turn increase the heart’s oxygen demand and may trigger ischemia.
Imbalance effects: age and gender issues
This study is more than just pooling data. It examines changes between age and gender carefully. Some findings stand out. Among young people aged 18-36, the risk of marijuana use and acute coronary syndrome is significantly higher. In one analysis, the odds ratio for the age group was 5.24.
In addition, an unrate result analyzed by the UK Biobank in 2024 shows that marijuana use is associated with increased cardiovascular mortality in women, but not high in men. This gender-based difference increases the complexity of the overall situation and emphasizes the need for more targeted research.
The meaning of the real world
While the review includes data from medical and recreational marijuana users, only one study specifically targets medical marijuana. Despite this, the key points are clear. “The findings outlined in this meta-analysis should raise awareness of the potential for cardiovascular harm caused by marijuana,” the authors wrote.
They recommend that doctors usually ask about marijuana use when evaluating patients with severe cardiovascular symptoms, especially because many users do not disclose the use of it, and some users may self-medicate without a prescription.
Key Points of Policy and Practice
The study authors highlighted the need for better real-world data, especially with accurate marijuana exposure measures. But based on current evidence, they suggest:
- Including marijuana in cardiovascular patient assessment
- Raise public awareness of the heart risks associated with marijuana
- Conduct further gender-specific and age-specific studies
What’s next?
As the global use of marijuana continues to rise, a need for nuanced understanding is needed. Will health risks vary based on dose, method of use, or cannabinoid profile? How do new high-rate strains change risk patterns? Unless we know more, this study urges caution.
One thing remains stable during a time of changing the law and evolving perspective: The heart does not lie.
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