Cannabis and adverse cardiovascular events: A systematic review and meta-analysis of observational studies

• Published in: Toxicology reports Vol. 10; pp. 537 - 543
• Main Authors: Theerasuwipakorn, Nonthikorn, Prechawat, Somchai, Chokesuwattanaskul, Ronpichai, Siranart, Noppachai, Marsukjai, Apichai, Thumtecho, Suthimon, Rungpradubvong, Voravut
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.01.2023; Elsevier
• Subjects: Cannabis; Cardiovascular event; Marijuana; Meta-analysis; Myocardial infarction; Stroke; Systematic review; Myocardial infarction; Cannabis; Stroke; Marijuana; Cardiovascular event; Systematic review; Meta-analysis
• ISSN: 2214-7500; 2214-7500
• DOI: 10.1016/j.toxrep.2023.04.011

Cannabis is the most used illicit drug in the world. Global trends of decriminalization and legalization of cannabis lead to various forms of cannabis use and bring great concerns over adverse events, particularly in the cardiovascular (CV) system. To date, the association between cannabis and adverse CV events is still controversial. We aim to conduct a systematic review and meta-analysis to assess the adverse CV events from cannabis use. A systematic search for publications describing the adverse CV events of cannabis use, including acute myocardial infarction (MI) and stroke, was performed via PubMed, Scopus, and Cochrane Library databases. Data on effect estimates in individual studies were extracted and combined via random-effects meta-analysis using the DerSimonian and Laird method, a generic inverse-variance strategy. Twenty studies with a total of 183,410,651 patients were included. The proportion of males was 23.7%. The median age and follow-up time were 42.4 years old (IQR: 37.4, 50.0) and 6.2 years (IQR: 1.7, 27.7), respectively. The prevalence of cannabis use was 1.9%. Cannabis use was not significantly associated with acute MI (pooled odds ratio (OR): 1.29; 95%CI: 0.80, 2.08), stroke (pooled OR 1.35; 95%CI: 0.74, 2.47), and adverse CV events (pooled OR: 1.47; 95%CI: 0.98, 2.20). The risk of adverse CV events including acute MI and stroke does not exhibit a significant increase with cannabis exposure. However, caution should be exercised when interpreting the findings due to the heterogeneity of the studies. [Display omitted] •Cannabis has been increasingly decriminalized or legalized for medical and recreational purposes in recent decades.•The association between cannabis and adverse CV events is still controversial.•This meta-analysis found that cannabis use was not significantly associated with acute MI, stroke, and adverse CV events.•The plausible explanation for the inconsistent association is attributed to how cannabis is consumed in each study.•Specific conditions of cannabis use e.g., preparation, route, dosage, duration, and time after exposure can affect outcomes and need further investigations.