Marijuana Use Tied to Increased Risk for Myocardial Infarction in People Aged 50 Years and Younger

People aged 50 years and younger who use marijuana are more vulnerable to experiencing adverse cardiovascular events compared with nonusers, according to the results of a new large multicenter retrospective study published in JACC: Advances.¹

“This analysis provides evidence linking cannabis-use to adverse cardiovascular events, including MI, ischemic stroke, HF and mortality. Notably, cannabis use appears to pose a substantial and independent risk for these outcomes, even in a population without traditional cardiovascular risk factors,” lead author Ibrahim Kamel, MD, from the Boston University School of Medicine, and colleagues reported in their paper published online on March 18, 2025.¹ Kamel is also presenting a meta-analysis on cannabis and acute MI risk at next week’s upcoming American College of Cardiology 2025 Scientific Session.

Marijuana use has become increasingly popular in the US. Currently, medical marijuana is legal in 39 US states, 3 territories, and the District of Columbia, and recreational marijuana use is legal in 24 states and the District of Columbia.² “While it has therapeutic benefits, cannabis consumption has been linked to adverse cardiovascular outcomes, especially myocardial infarction (MI),” Kamel and colleagues wrote.¹

To evaluate the potential cardiovascular risks associated with cannabis use, investigators utilized deidentified electronic medical records from the TriNetX health research network, examining adults aged 50 years or younger between 2010 and 2018. The study included 93 267 cannabis users and 4 543 361 non-users, with a propensity score matching process ensuring balanced baseline characteristics between the groups. The analysis focused on individuals without pre-existing conditions such as hypertension, diabetes, hyperlipidemia, or tobacco use to isolate cannabis use as a potential risk factor.¹

Researchers observed that cannabis users had a more than sixfold increased risk of MI (risk ratio [RR]: 6.185; 95% CI: 4.892-7.82) compared to non-users. The risk of ischemic stroke was also significantly elevated (RR: 4.333; 95% CI: 3.419-5.493). Additionally, cannabis users faced a 3.24 times greater risk of experiencing major adverse cardiovascular events (MACE), which included ischemic stroke, coronary revascularization, and ventricular arrhythmia.¹

The findings underscore the need for increased awareness among clinicians and public health officials regarding the cardiovascular risks associated with cannabis use. As cannabis legalization expands globally, its potential health implications warrant closer scrutiny to guide risk assessment and patient education strategies.¹

“Asking about cannabis use should be part of clinicians’ workup to understand patients’ overall cardiovascular risk, similar to asking about smoking cigarettes,” Kamel said in a press release.³ “At a policy level, a fair warning should be made so that the people who are consuming cannabis know that there are risks.”

Despite the compelling associations observed, the study has limitations, including a lack of detailed data on cannabis consumption patterns, dosage, and method of use. Additionally, electronic medical records may contain inconsistencies in self-reported cannabis use.¹

“This study has limitations due to lack of detailed cannabis consumption data and potential misclassification. Future research should investigate the dose-response relationship and the effects of synthetic cannabinoids,” the research team noted.¹

References:

1. Kamel I, Mahmoud AK, Twayana AR, et al. Myocardial infarction and cardiovascular risks associated with cannabis use: A multicenter retrospective study. JACC Adv. Published online March 18, 2025. doi:10.1016/j.jacadv.2025.101698

2. National Conference of State Legislatures. State Medical Cannabis Laws. Updated March 6, 2025. Accessed March 24, 2025. https://www.ncsl.org/health/state-medical-cannabis-laws

3. Cannabis Users Face Substantially Higher Risk of Heart Attack. News release. American College of Cardiology. March 18, 2025. Accessed March 24, 2025. https://www.acc.org/About-ACC/Press-Releases/2025/03/17/15/35/Cannabis-Users-Face-Substantially-Higher-Risk