Comparison of Atherosclerotic Cardiovascular Risk Factors and Cardiometabolic Profiles Between Current and Never Users of Marijuana

CIRCULATION: CARDIOVASCULAR QUALITY AND OUTCOMES

Article Information

  • Title: Comparison of Atherosclerotic Cardiovascular Risk Factors and Cardiometabolic Profiles Between Current and Never Users of Marijuana

  • Authors: Hassan A. Alhassan, MBChB, MPH; Harriet Akunor, MD, MPH; Ato Howard, MD; Joseph Donohue, MD; Aleesha Kainat, MD; Henry K. Onyeaka, MBChB, MPH; Aryan Aiyer, MD

  • Publication Date: November 2023

  • Journal: Circulation: Cardiovascular Quality and Outcomes

  • DOI: 10.1161/CIRCOUTCOMES.122.009609

  • Correspondence: Hassan A. Alhassan, MBChB, MPH, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213. Email: adamdr90@gmail.com

  • Supplemental Material: Available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCOUTCOMES.122.009609

  • Conflict of Interest Statement: None reported.

  • Source of Funding: Supported by the Conrad Smith Endowed Fund, University of Pittsburgh Department of Medicine.

Background

  • Prevalence of Marijuana Use: Increasing in the United States as states liberalize medical and recreational usage.

  • Health Effects: Limited data on the health effects of marijuana, with an estimated 2 million US adults with cardiovascular disease using marijuana in 2016.

  • Observational Studies Link: Some studies suggest a link between marijuana use and increased adverse atherosclerotic cardiovascular disease (ASCVD) outcomes, including angina, myocardial infarction, and cardiovascular death.

  • Mixed Results: Observational studies on the relationship between marijuana and traditional ASCVD risk factors like hypertension, diabetes, and hyperlipidemia show inconsistent results, with some reporting high burdens and others reporting protective effects.

  • Potential Mechanisms: Marijuana exposure could induce endothelial dysfunction, metabolic dysregulation, and inflammation which may lead to atherosclerosis. Interaction with cytochrome P450 enzymes raises concerns about negative interactions with cardiovascular medications.

Methods

  • Study Design: Cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018.

  • Participant Selection: Nonpregnant adults aged 18–59 without cardiovascular disease were included based on self-reporting of marijuana use.

  • User Classification: Current users (used within the past month) and never users were compared regarding ASCVD risk factors and biomarkers. Former users were excluded from analysis.

  • Statistical Analysis: Inverse probability of treatment weighting (IPW) was used to adjust for sociodemographic and lifestyle factors.

Results

  • Cohort Description: Out of 13,965 participants (average age 37.5, 51.2% female), 26.6% were current marijuana users, predominantly male and low-income individuals who were more likely to also be tobacco users.

  • Comparative Analysis: No significant differences were found in the burden and control of hypertension (19.3% vs 18.8%, P=0.76), dyslipidemia (24.0% vs 19.9%, P=0.13), diabetes (4.8% vs 6.4%, P=0.19), and obesity (35.8% vs 41.3%, P=0.13) among current versus never users.

  • ASCVD Risk Scores: Mean 10-year ASCVD risk scores (2.8% vs 3.0%, P=0.49) and 30-year Framingham risk scores (22.7% vs 24.2%, P=0.25) were similar between groups.

  • Cardiometabolic Profiles: Similarity in profiles including high-sensitivity C-reactive protein, neutrophil-lymphocyte ratio, low-density lipoprotein, total cholesterol, and hemoglobin A1C between user groups.

Conclusions

  • Key Findings: No association was found between self-reported marijuana use and increased burden of traditional ASCVD risk factors, long-term ASCVD risk, or cardiometabolic profiles.

  • Further Research: Needed to explore mechanisms between possible adverse cardiovascular outcomes and marijuana use.

  • Study Limitations: Cross-sectional design limits causal inference; data on dose and route of administration were not collected; the results may not apply to synthetic cannabinoid users.

Keywords

  • Atherosclerosis, Cardiovascular Disease, Marijuana Use, Risk Factors, Tobacco

Abbreviations

  • ASCVD: Atherosclerotic Cardiovascular Disease

  • hs-CRP: High-Sensitivity C-Reactive Protein

  • IPW: Inverse Probability of Treatment Weighting

  • MEC: Mobile Examination Centers

  • PCE: Pooled Cohort Equations

Supplementary Information

  • Tables and Figures: Data presented in multiple tables summarize participant characteristics, prevalence rates, and biomarker distributions for current and never users of marijuana.

  • Research Ethics: Approved by the Research Ethics Review Board; written informed consent was obtained from participants.

Additional Notes

  • Current legal and healthcare contexts required addressing the cardiovascular implications of marijuana use due to changing state laws concerning its use. More rigorous longitudinal and interventional studies are necessary to ascertain the long-term cardiovascular health impacts of marijuana, particularly amidst rising product potency in modern cannabis consumption.