Cannabis/Cannabinoids & Cardiovascular Risk – Systematic Review + Meta‑analysis (2016–2023)

Cannabis/Cannabinoids & Cardiovascular Risk

Systematic Review & Meta‑analysis (search 2016–2023; last search Sep 20, 2023)
Population: cannabis/cannabinoid users Outcomes: ACS, Stroke, CV death Studies: 24 (17 cross‑sectional, 6 cohort, 1 case‑control) Model: DerSimonian‑Laird random effects Registration: PROSPERO CRD42023401401

Bottom line

Positive associations between cannabis use and major adverse cardiovascular events. Pooled RRs: ACS 1.29 (95% CI 1.05–1.59), Stroke 1.20 (1.13–1.26), Cardiovascular death 2.10 (1.29–3.42). Composite ACS+stroke (2 studies) not statistically significant. Cohort‑only analysis similar (RR 1.32, 1.01–1.73).

Methods

  • Databases: PubMed, Web of Science, Scopus; window 1 Jan 2016 – 31 Jan 2023; last search 20 Sep 2023.
  • Designs: cross‑sectional, cohort, case‑control; adjusted estimates preferred.
  • Outcomes (MACE): cardiovascular death, non‑fatal ACS/MI, non‑fatal stroke.
  • Quality: ROBINS‑E risk‑of‑bias for exposures.
  • Meta‑analysis: random effects (inverse variance).

Strengths

  • Focus on adjusted real‑world pharmacoepidemiology.
  • Prespecified protocol (PROSPERO) and bias assessment (ROBINS‑E).
  • Consistent signal across designs; cohort‑restricted analysis similar.

Limitations

  • Predominance of cross‑sectional data; residual confounding likely (tobacco, other substances).
  • Exposure heterogeneity (dose, route, THC/CBD ratio, medical vs non‑medical) rarely granular.
  • Composite ACS+stroke non‑significant in limited data; publication bias can’t be excluded.

Primary outcomes (pooled risk ratios)

Pooled RR (95% CI listed below chart)
Labels show pooled RR. 95% CIs: ACS 1.05–1.59; Stroke 1.13–1.26; CV death 1.29–3.42.

Clinical takeaways

  • Ask about cannabis in patients with ACS, stroke, or unexplained cardiovascular events.
  • Risk appears modest for ACS/stroke but larger for cardiovascular death; counsel accordingly.
  • Decision‑making should consider co‑exposures (tobacco/vaping, stimulants), dose, and route.

Reference

Storck W, Elbaz M, Vindis C, Déguilhem A, Lapeyre‑Mestre M, Jouanjus E. Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta‑analysis. Correspondence: emilie.jouanjus@univ-tlse3.fr. (Search window 2016–2023; last search 20 Sep 2023).