Associations Between Marijuana Use and Cardiovascular Risk Factors and Outcomes: A Systematic Review
Open accessAbstract
Background: Marijuana use is increasing in the United States, and its effect on cardiovascular health is unknown. Purpose: To review harms and benefits of marijuana use in relation to cardiovascular risk factors and clinical outcomes. Data Sources: PubMed, MEDLINE, EMBASE, PsycINFO, and the Cochrane Library between 1 January 1975 and 30 September 2017. Study Selection: Observational studies that were published in English, enrolled adults using any form of marijuana, and reported on vascular risk factors (hyperglycemia, diabetes, dyslipidemia, and obesity) or on outcomes (stroke, myocardial infarction, cardiovascular mortality, and all-cause mortality in cardiovascular cohorts). Data Extraction: Study characteristics and quality were assessed by 4 reviewers independently; strength of evidence for each outcome was graded by consensus. Data Synthesis: 13 and 11 studies examined associations between marijuana use and cardiovascular risk factors and clinical outcomes, respectively. Although 6 studies suggested a metabolic benefit from marijuana use, they were based on cross-sectional designs and were not supported by prospective studies. Evidence examining the effect of marijuana on diabetes, dyslipidemia, acute myocardial infarction, stroke, or cardiovascular and all-cause mortality was insufficient. Although the current literature includes several long-term prospective studies, they are limited by recall bias, inadequate exposure assessment, minimal marijuana exposure, and a predominance of low-risk cohorts. Limitation: Poor- or moderate-quality data, inadequate assessment of marijuana exposure and minimal exposure in the populations studied, and variation in study design. Conclusion: Evidence examining the effect of marijuana on cardiovascular risk factors and outcomes, including stroke and myocardial infarction, is insufficient. Primary Funding Source: National Heart, Lung, and Blood Institute. (PROSPERO: CRD42016051297).
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Although no definitive causal effects have been established, there are case reports of stroke, acute coronary syndrome, and cardiac arrhythmias associated with use of cannabis.
“Although no definitive causal effects have been established, there are case reports of stroke, acute coronary syndrome, and cardiac arrhythmias associated with use of cannabis.120,121”
From Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions (2024) · cites this paper as [121]
The Conclusion says evidence on marijuana’s cardiovascular effects, including stroke and myocardial infarction, is insufficient. The Results discuss myocardial infarction, stroke, and irregular heartbeat, but the Methods (Study Selection) explicitly exclude case reports and case series. This paper therefore supports the uncertainty and discussion of these outcomes, not the claim that it reports case reports of all three. (LLM, conf=0.88)
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“120,121 122–124 Significant decline in sperm count, concentration, and motility, as well as an increase in abnormal sperm morphology have been reported.”
Background
- Authors
- Ravi, D., Ghasemiesfe, M., Korenstein, D., Cascino, T., & Keyhani, S.
- Affiliations
- The Wright Center for Graduate Medical Education (US)
- San Francisco VA Medical Center (US)
- Memorial Sloan Kettering Cancer Center (US)
- University of Michigan (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2018-02-06
- Volume
- 168
- Issue
- 3
- Pages
- 187-194
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC6157910
- OpenAlex
- W2788920571
- Cited by
- 98
- References
- 38
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 8 · 2023: 13 · 2022: 17 · 2021: 19 · 2020: 13 · 2019: 14 · 2018: 6
- FWCI
- 1.52
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (1R01HL130484-01A1)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Keywords
- cannabis use, cardiovascular risk factors, cardiovascular outcomes, stroke, myocardial infarction, cardiovascular mortality, all-cause mortality, diabetes mellitus, dyslipidemia, obesity, hyperglycemia
- MeSH terms
- Marijuana Use, Cardiovascular Diseases, Humans, Risk Factors, United States
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