From the Guidelines
Cannabis use is associated with an increased risk of atherosclerotic plaque levels, particularly in younger individuals, due to its effects on cardiovascular risk factors and potential to cause inflammation and oxidative stress in blood vessels. The most recent evidence from the 2024 guideline for the primary prevention of stroke suggests a dose-dependent relationship between cannabis use and stroke, with observational data identifying that cannabis use increases the odds of stroke 1. While the exact mechanism by which cannabis contributes to atherosclerosis is still being researched, it is believed that the compounds in cannabis, particularly THC, can increase heart rate and blood pressure, leading to inflammation and oxidative stress in blood vessels 1.
Some key points to consider include:
- The method of cannabis consumption matters, with smoking cannabis exposing users to harmful combustion products similar to tobacco smoke, which can damage blood vessels 1.
- Alternative consumption methods like edibles may reduce some risks associated with smoking, but do not eliminate all cardiovascular concerns.
- Cannabis use has been linked to an increased risk of heart attacks and strokes, which are conditions related to plaque buildup 1.
- The American Heart Association has acknowledged the potential risks of cannabis use on cardiovascular health, particularly in younger individuals 1.
Given the emerging evidence and potential risks, it is recommended that individuals who use cannabis, particularly those with existing cardiovascular risk factors or conditions, discuss their cannabis use with their healthcare provider to assess and mitigate potential risks to their cardiovascular health.
From the Research
Atherosclerotic Plaque Levels and Cannabis Use
- The relationship between cannabis use and atherosclerotic plaque levels is complex and not fully understood, with limited direct evidence available 2, 3.
- Some studies suggest that cannabis may have therapeutic benefits, but few are cardiovascular in nature, and many of the concerning health implications of cannabis include cardiovascular diseases 2.
- Activation of cannabinoid receptors may contribute to the pathogenesis of atherosclerosis, and clinically, there are reports linking marijuana smoking to the precipitation of angina and acute coronary syndromes 3.
- However, modulation of the endocannabinoid system by a noninhalation route may have a salutary effect on the development of atherosclerosis, suggesting a potential "marijuana paradox" 3.
Risk Factors and Health Implications
- Regular use of high THC products can produce addiction and acute consumption of high THC doses can cause time-limited mental, gastrointestinal, and cardiovascular problems 4.
- Chronic patterns of cannabis use have been associated with multiple adverse outcomes, including disrupted learning, impaired cognitive performance, and increased risk of cardiovascular problems 4.
- The evidence on the safety and efficacy of medical cannabis is inconclusive, but it may produce small to modest benefits in treating chronic pain, muscle spasticity, and chemotherapy-induced nausea and vomiting 4, 5.
Safety Considerations and Risk Mitigation
- Clinicians should be aware of the potential risks and benefits of medical cannabis and take a structured approach to assessing and monitoring patients using cannabis 5.
- Risk mitigation strategies, such as appropriate chemovar selection, routes of administration, and dosing, can help reduce the risks associated with medical cannabis use 5.
- Patients should be informed of the potential risks and benefits of cannabis use, and clinicians should be cautious when recommending cannabis to certain populations, such as pregnant women, drivers, and older adults 6, 5.