A GROWING body of evidence highlights the potential cardiovascular risks associated with cannabis use, raising important public health concerns as global consumption continues to rise. Despite remaining illegal for recreational purposes in most European countries, cannabis use, particularly among young people, remains high, as seen in France. Germany, however, legalised recreational cannabis in April 2024, reflecting a broader trend of regulatory shifts and a changing public perception of the drug.
These developments have coincided with rising potency in cannabis products, especially higher concentrations of THC, which may elevate health risks. Of particular concern are individuals using cannabis to self-manage medical conditions without medical supervision.
A recent meta-analysis aimed to quantify the risk of major adverse cardiovascular events (MACE) linked to cannabis use by evaluating real-world observational data. The analysis of 24 studies, including one on medical cannabis, identified a positive association between cannabis use and MACE. Supporting studies also indicated elevated risks of myocardial infarction and stroke, especially among young adults and frequent users. While some findings were inconclusive or limited by sample size and methodological challenges, others revealed statistically significant associations. Notably, women appeared to face a higher risk of cardiovascular mortality from heavy cannabis use, as observed in a UK Biobank analysis.
The pharmacological basis of this risk is increasingly understood. THC, the main psychoactive compound, can stimulate the sympathetic nervous system, potentially causing tachycardia, vasoconstriction, and increased oxygen demand, all of which may contribute to ischaemia. By contrast, CBD may offer anti-inflammatory benefits, although its cardiovascular effects remain less clear.
Although the study followed rigorous methodological standards, several limitations were identified, including inconsistent cannabis exposure data, potential misclassification, and reliance on cross-sectional studies. These factors limit causal inference and highlight the need for more robust longitudinal research with accurate exposure measurement.
Overall, the study underscores a consistent association between cannabis use and adverse cardiovascular outcomes. As patterns of use evolve, it is increasingly important for healthcare professionals to routinely enquire about cannabis consumption in patients presenting with cardiovascular symptoms.
Reference
Storck W et al. Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis. Heart. 2025;DOI:10.1136/heartjnl-2024-325429.
