Treat it like tobacco: avoid criminalizing it, discourage its use, and protect bystanders, says editorial.
Cannabis use is associated with twice the risk of dying from cardiovascular disease, along with significantly increased risks of stroke and acute coronary syndrome, which is a sudden reduction or blockage of blood flow to the heart. These findings come from a pooled analysis of real-world data published in the journal Heart.
In a related editorial, the authors argue that cannabis should be regulated like tobacco: not criminalized, but actively discouraged, with measures in place to protect others from secondhand vapor exposure.
According to the researchers, the use of cannabis and cannabinoids has risen sharply over the past decade. Legalization in some regions and broader medicinal use have likely shifted public perceptions of risk and contributed to the drug’s growing popularity.
Gaps in risk understanding
Although earlier studies have linked cannabis use to cardiovascular issues, the exact level of risk has remained unclear. This uncertainty is especially important given recent increases in cannabis use and the growing potency of available products, the researchers note.
To provide more clarity, the research team searched scientific databases for large observational studies published between January 2016 and December 2023. They focused on studies that examined cannabis use and major cardiovascular outcomes, including death from cardiovascular disease, heart attack, and stroke.
Out of 3,012 articles initially identified, 24 studies were selected for pooled analysis. These studies included data on approximately 200 million people and consisted of 17 cross-sectional studies, 6 cohort studies, and 1 case-control study.
Study participants were mostly aged between 19 and 59. And in those studies where sex was recorded, cannabis users tended to be mostly male and younger than non-users.
Significant increases in cardiovascular risk
The analysis revealed heightened risks for cannabis use: 29% higher for acute coronary syndrome; 20% higher for stroke; and a doubling in the risk of dying from cardiovascular disease.
The researchers acknowledge that there was a moderate to high risk of bias in most of the included studies, largely because of lack of information on missing data and imprecise measures of cannabis exposure. And most of the included studies were observational, precluding the ability to draw causal inferences from the data. Several used the same data.
Notwithstanding these caveats, the researchers say that theirs is an exhaustive analysis of published data on the potential association between cannabis use and major cardiovascular disease and provides new insights from real-world data.
In a linked editorial, Emeritus Professor Stanton Glantz of the University of California at San Francisco and Dr Lynn Silver of the Public Health Institute, Oakland, California, and Department of Epidemiology and Biostatistics, University of California at San Francisco, say the study “raises serious questions about the assumption that cannabis imposes little cardiovascular risk.”
Need to investigate different cannabis forms
More research is clearly needed to clarify whether cardiovascular risks are limited to inhaled products or extend to other forms of cannabis exposure, they suggest. Cannabis is now generally more potent and has diversified into a wide array of inhaled high potency cannabis concentrates, synthetic psychoactive cannabinoids, and edibles, they point out.
“How these changes affect cardiovascular risk requires clarification, as does the proportion of risk attributable to cannabinoids themselves versus particulate matter, terpenes or other components of the exposure,” they say.
They conclude: “Cannabis needs to be incorporated into the framework for prevention of clinical cardiovascular disease. So too must cardiovascular disease prevention be incorporated into the regulation of cannabis markets. Effective product warnings and education on risks must be developed, required, and implemented.
“Cardiovascular and other health risks must be considered in the regulation of allowable product and marketing design as the evidence base grows. Today, that regulation is focused on establishing the legal market with woeful neglect of minimizing health risks.
“Specifically, cannabis should be treated like tobacco: not criminalised, but discouraged, with protection of bystanders from secondhand exposure.”
Reference: “Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis” by Wilhelm Storck, Meyer Elbaz, Cécile Vindis, Amélia Déguilhem, Maryse Lapeyre-Mestre and Emilie Jouanjus, 17 June 2025, Heart.
DOI: 10.1136/heartjnl-2024-325429
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10 Comments
“The researchers acknowledge that there was a moderate to high risk of bias in most of the included studies, ”
Lol .. No kidding…..
It sounds like you are interpreting that out-of-context remark in a way to rationalize your approval of its use. The implication is perhaps better characterized in a following remark — “the study ‘raises serious questions about the assumption that cannabis imposes little cardiovascular risk.’” It implies that the previous studies were wrongly biased in favor of the use of marijuana.
Then why did they add it? It’s a disclaimer because they set out to find harm. A good study would have focused on states that legalized early like California and Colorado. Are these states having higher incidences of heart and stroke deaths? This drug is being legalized regardless of what we think or want, so these studies must be done carefully and accurately as possible so we have good data to enact proper policy and safety.
The real cardio vascular heart disease problem is it’s on going criminalisation it is nothing like tobacco being an introductory psychedelic & needed 4 human health.
Are you seriously suggesting that marijuana is needed to be healthy? Where is the evidence for that? How did Eskimos obtain marijuana when they didn’t have agriculture?
Does grow in Alaska USA/canada so Inuit peoples would have acquired cannabis,oils would be safer
It was legalized in NYS purely to keep the masses stupid. Hence recent election results
Republicans don’t smoke weed generally so you are in error friend.
Are there reduced incidents of cancer? That could raise the percentage of other things, like cardio problems, as less of one leaves more of the other.
Alcohol, tobacco, pot…all eventually cause illness/death… but it’s benadryl that doctors are trying to get rid of?! Uh huh, OK, whatever.