New study links cannabis use to increased cardiovascular risk

Cannabis use, including marijuana, appears to be linked with increased cardiovascular risk, especially for stroke, making it an important consideration for heart disease and stroke prevention and counseling, according to independent, new preliminary research to be presented at the American Heart Association's Scientific Sessions 2026. The meeting, Nov. 6-9, in Chicago, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

Regardless of the form (smoked or edible, etc.), cannabis use, which includes marijuana, was associated with the same outcome. From a scientific standpoint, cannabis is the plant, while marijuana is a common term for cannabis products that contain enough THC to produce psychoactive effects.

Previous research has indicated that cannabis use is rapidly increasing in the United States, with 1 in 6 adults in 2024 reporting having used it within the last month, up from 1 in 10 in 2020 – a 51% increase." 

Aabha Divya, M.B.B.S., M.Ch., study author, assistant professor, division of cardiothoracic surgery, Tulane University School of Medicine, New Orleans

Between 2016 and 2020, prior research found that cannabis use was linked to poor cardiovascular outcomes, and using cannabis more days per month was associated with an increased risk of poor cardiovascular outcomes.

"We wanted to expand on this earlier work because cannabis use has become increasingly common in the United States, as recreational legalization and commercial availability of various products with cannabis have also expanded. Previous studies have raised concerns about possible cardiovascular effects; however, the results have not been consistent," Divya said.

For the current study, the researchers analyzed pooled data for almost half a million adults in the U.S. who responded to telephone interview questions about cannabis use as part of the Behavioral Risk Factor Surveillance System (BRFSS). This was limited to jurisdictions with available cannabis-use information between 2020 and 2024. Participants also reported if a health professional had ever told them they had cardiovascular disease - if they had experienced a heart attack or stroke or if they had been diagnosed with coronary heart disease.

What are the main findings?

• Compared with people who reported no cannabis use, those who reported using cannabis on 1 to 5 days per month had 23% higher odds of reporting a history of cardiovascular disease.
• Heavy cannabis users, defined as those who reported using it for 16 to 30 days per month, had 21% higher odds of reporting a history of cardiovascular disease.
• The strongest link between cannabis use and cardiovascular disease was with stroke. Reported low-frequency cannabis use was associated with 40% higher odds of stroke, and heavy use had 25% higher odds of stroke.
• Researchers did not see a statistically significant association between the reported frequency of cannabis use and heart attack.

"We were surprised to find that the link between cannabis use and cardiovascular disease was not straightforward. We expected that the chances of heart disease would gradually rise as people used cannabis more often, but that wasn't the case. Both low-use and heavy-use groups had higher odds of developing heart disease," Divya said.

"As cannabis use becomes more common, it is increasingly important that people and their healthcare professionals include it in conversations about cardiovascular health, just as they discuss tobacco, alcohol and other commonly used substances," she added.

Robert L. Page II, Pharm.D., M.S.P.H., FAHA, chair of the writing group for the American Heart Association's 2020 cannabis scientific statement, said, "Unfortunately, many patients who use cannabis may also smoke tobacco, which completely clouds the issue when addressing atherosclerotic cardiovascular disease risk. In patients who use both, cannabis has always been considered an innocent bystander; however, this is not the case. This is the second observational study to suggest that cannabis exposure (without tobacco smoking) may be a potential risk factor for developing cardiovascular disease. Overall, cannabis is beginning to emerge as a major contributor to premature heart disease in young and older adults, which can lead to serious cardiovascular events. To this end, clinicians should be addressing cannabis use with their patients as they would tobacco use when considering the risk of cardiovascular disease." Page is also a professor in the department of clinical pharmacy and the department of physical medicine/rehabilitation at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences in Aurora, Colorado, and was not a part of this study.

What are the study details, background, design and limitations?

• The study included 442,906 U.S. adults (average age of 49 years; approximately half women) surveyed by telephone as part of the BRFSS.
• The study analyzed 2020-2024 BRFSS data from states that included the optional marijuana module in their telephone surveys, with 16-24 states participating each year. The cannabis questions were optional, and the analysis did not include all U.S. states.
• The survey asked about the number of days participants used cannabis (smoking, vaping or ingesting gummies or other cannabis-containing foods) in the previous month. Use was characterized as none; low frequency for 1-5 days in the past 30 days; moderate frequency for 6-15 days of the month; or heavy frequency for 16-30 days out of the previous month.
• Participants were also asked whether they had previously been diagnosed with a heart attack, heart disease, heart-related chest pain or stroke.
• The association between cannabis use and heart disease was calculated after adjusting for several heart disease risk factors, including demographics, tobacco smoking, alcohol use, obesity, diabetes, chronic kidney disease, physical inactivity, level of education and income.
• The study is limited by presenting associations from a single point in time, so it cannot prove that cannabis use causes heart disease. In addition, it relied on participants' self-reported information about their cannabis use and heart-disease diagnoses (making them subject to potential errors in memory), and the study did not have any information about the potency of the cannabis product used or the amount consumed. People may also have reduced or stopped cannabis use after a diagnosis, and the no-recent-use group could include former users.