The association between regular cannabis use, with and without tobacco co-use, and adverse cardiovascular outcomes: cannabis may have a greater impact in non-tobacco smokers

ABSTRACT

Background

Understanding the potential impact of cannabis use on cardiovascular health is increasingly important as cannabis use rises in the U.S.

Objectives: This study evaluated the associations between regular cannabis use, with and without tobacco co-use, and cardiovascular outcomes.

Methods

Analysis of a limited dataset obtained through IBM Watson Health Explorys, a platform integrating electronic health record data. Matched controls using Mahalanobis distance within propensity score calipers were defined for: 1) cannabis-using patients (n = 8,944; 43% female); and subgroups of cannabis-using patients: 2) with an encounter diagnosis for tobacco use disorder (TUD; n = 4,682); and 3) without a TUD diagnosis (non-TUD; n = 4,262). Patients had ≥1 blood pressure measurement and blood chemistry lab result in the MetroHealth System (Cleveland, Ohio). Cannabis-using patients had an encounter diagnosis of cannabis abuse/dependence and/or ≥2 cannabis-positive urine drug screens. Control patients, with no cannabis-use-documentation, were matched to the cannabis-using patients on demographics, residential zip code median income, body mass index, and, for the total sample, TUD-status. Outcomes were encounter diagnosis (yes/no) of cerebrovascular accident (CVA), heart arrhythmia, myocardial infarction, subarachnoid hemorrhage (SAH), and all-cause mortality.

Results

TUD-patients had the greatest prevalence of cardiovascular disease, regardless of cannabis-use indication. In the total sample and non-TUD subgroup, regular cannabis use was significantly associated with greater risk for CVA, arrhythmia, SAH, and mortality. In the TUD subgroup, regular cannabis use was significantly associated with greater risk for arrhythmia and SAH.

Conclusions

Cannabis use is associated with significantly greater risk of adverse cardiovascular diagnoses and overall death, particularly in non-tobacco users.

KEYWORDS:

• Cannabis
• cardiovascular
• electronic health record (EHR)
• mortality

Declarations of interest

TW, JT, and DL declare no conflicts of interest. DCK is the Chief Medical Informatics Officer of the MetroHealth System. In exchange for contributing de-identified data to the Explorys network, the MetroHealth System receives access to the Explorys Cohort Discovery tool, which was used to conduct this study. Neither DCK nor the MetroHealth System have any direct financial ties to Explorys (IBM Watson Health).

Supplementary material

Supplementary data for this article can be accessed here.

Additional information

Funding

This work was supported by the National Institute on Drug Abuse (NIDA) under grant number UG1DA013732.