Cannabis Use Tied to Higher Odds of Stroke, Cardiovascular Disease

Cannabis use was associated with higher odds of self-reported atherosclerotic cardiovascular disease (ASCVD), particularly stroke, among US adults in a cross-sectional analysis of Behavioral Risk Factor Surveillance System (BRFSS) data presented at the American Heart Association (AHA) Scientific Sessions 2026.^1,2

Compared with no use, cannabis use on 1 to 5 days per month was associated with 23% higher odds of reported cardiovascular disease, and heavy use on 16 to 30 days per month with 21% higher odds, according to the AHA.² The strongest association was with stroke, with 40% higher odds for low-frequency use and 25% higher odds for heavy use.² No statistically significant association was observed between cannabis use frequency and myocardial infarction (MI).²

“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,” said Aabha Divya, MBBS, MCh, study author and assistant professor in the division of cardiothoracic surgery at the Tulane University School of Medicine in New Orleans.²

BRFSS analysis design and trends in cannabis use frequency

The investigators pooled 2020 to 2024 BRFSS data from states including the optional marijuana module, with 16 to 24 states participating each year.² Adults were grouped by past-month use as none, low (1 to 5 days), moderate (6 to 15 days), or heavy (16 to 30 days), and ASCVD was defined as self-reported MI, coronary heart disease or angina, or stroke.^1,2 Survey-weighted logistic regression adjusted for demographics, tobacco smoking, alcohol use, obesity, diabetes, hypertension, chronic kidney disease, physical inactivity, education, and income.¹

The AHA reported 442,906 adults with an average age of 49 years, approximately half of whom were women, while the abstract lists 577,057 adults.^1,2 Any past-month cannabis use rose from 10.5% in 2020 to 16.0% in 2024, a 52% relative increase.¹ Cannabis use included smoking, vaping, and ingesting edibles, and the association was similar regardless of the form used, according to the AHA.²

Cannabis and ASCVD in women, never-smokers, and young adults

In the abstract, the investigators reported primary adjusted estimates were directionally higher across frequency categories but did not reach statistical significance.¹ A significant cannabis-by-sex interaction was observed, with moderate use significantly associated with ASCVD among women.¹ Among never-smokers, low-frequency cannabis use was independently associated with ASCVD.¹

Among adults aged 18 to 44 years without diabetes, hypertension, or obesity, heavy cannabis use was significantly associated with ASCVD.¹ Associations were stronger in states with recreational legalization, and the abstract did not report odds ratios for these subgroups.¹ According to the AHA, the cross-sectional design cannot establish causation, the analysis relied on self-reported use and diagnoses, product potency and amount were unavailable, and the no-recent-use group could include former users.²

“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,” said Robert L. Page II, PharmD, MSPH, FAHA, chair of the writing group for the AHA’s 2020 cannabis scientific statement and professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, who was not involved in the study.²

The investigators concluded the findings support incorporating cannabis exposure into cardiovascular risk assessment and prevention counseling.¹ The findings are preliminary until published in a peer-reviewed journal.²

References

1. Dalal N, Divya A. Cannabis use and atherosclerotic cardiovascular disease among US adults. Presented at: American Heart Association Scientific Sessions 2026; November 9, 2026; Chicago, IL. Abstract Mo3041.

2. American Heart Association. Cannabis use linked to an increased risk of cardiovascular disease, especially strokes. Published November 2, 2026. Accessed November 7, 2026. https://newsroom.heart.org/news/cannabis-use-linked-to-an-increased-risk-of-cardiovascular-disease-especially-strokes