Cannabis and Cardiovascular Disease


Purpose of Review

The use of recreational drugs has increased globally, with the most commonly used recreational drug being cannabis. As of 2019, 10 states and the District of Columbia have legalized cannabis for recreational use, with more states potentially joining this movement. With the increased legalization of cannabis, leading to even greater recreational and medicinal use, it is important to recognize its effect on cardiovascular health. We propose to review the current literature regarding the pathophysiology of endocannabinoids, their hemodynamic effects, and their association with acute and chronic cardiovascular outcomes.

Recent Findings

The demonstrated effects of the endocannabinoid system on the cardiovascular system at the cellular level have led to great interest regarding its potential clinical impact. A number of studies have attempted to characterize the hemodynamic effects of cannabis use as well as its potential negative impact on the cardiovascular system, but the data are inconclusive at this time. The largest prospective study to date, the CARDIA study, failed to show an association between lifetime or recent cannabis use and cardiovascular events.


There is suggestion on a molecular level and based on retrospective analyses that cannabis may have a negative impact on the cardiovascular system. However, prospective clinical data has not confirmed these suggested findings. Further research is needed to better elucidate the association, if any, between cannabis and cardiovascular disease.

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  1. 1.

    Degenhardt L, Whiteford HA, Ferrari AJ, Baxter AJ, Charlson FJ, Hall WD, et al. Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382:1564–74.

    Article  Google Scholar 

  2. 2.

    Substance Abuse and Mental Health Services Administration. Results from the 2015 National Survey on Drug Use and Health: detailed tables. Accessed 6 March 2019.

  3. 3.

    National Conference of State Legislatures. Marijuana overview. Accessed 6 March 2019.

  4. 4.

    Singh A, Saluja S, Kumar A, Agrawal S, Thind M, Nanda S, et al. Cardiovascular complications of marijuana and related substances: a review. Cardiol Ther. 2018;7:45–59.

    Article  Google Scholar 

  5. 5.

    Badowski ME, Perez SE. Clinical utility of dronabinol in the treatment of weight loss associated with HIV and AIDS. HIV AIDS (Auckl). 2016;8:37–45.

    CAS  Google Scholar 

  6. 6.

    Hammell DC, Zhang LP, Ma F, Abshire SM, McIlwrath SL, Stinchcomb AL, et al. Transdermal cannabidiol reduces inflammation and pain-related behaviours in a rat model of arthritis. Eur J Pain. 2016;20:936–48.

    CAS  Article  Google Scholar 

  7. 7.

    Pacher P, Steffens S, Hasko G, Schindler TH, Kunos G. Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol. 2018;15:151–66.

    CAS  Article  Google Scholar 

  8. 8.

    Pacher P, Batkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev. 2006;58:389–462.

    CAS  Article  Google Scholar 

  9. 9.

    Montecucco F, Di Marzo V. At the heart of the matter: the endocannabinoid system in cardiovascular function and dysfunction. Trends Pharmacol Sci. 2012;33:331–40.

    CAS  Article  Google Scholar 

  10. 10.

    Pacher P, Mechoulam R. Is lipid signaling through cannabinoid 2 receptors part of a protective system? Prog Lipid Res. 2011;50:193–211.

    CAS  Article  Google Scholar 

  11. 11.

    Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42:327–60.

    CAS  Article  Google Scholar 

  12. 12.

    Solowij N. Peering through the haze of smoked vs vaporized cannabis-to vape or not to vape? JAMA Netw Open. 2018;1:e184838.

    Article  Google Scholar 

  13. 13.

    Spindle TR, Cone EJ, Schlienz NJ, Mitchell JM, Bigelow GE, Flegel R, et al. Acute effects of smoked and vaporized cannabis in healthy adults who infrequently use cannabis: a crossover trial. JAMA Netw Open. 2018;1:e184841.

    Article  Google Scholar 

  14. 14.

    Rubinstein ML, Delucchi K, Benowitz NL, Ramo DE. Adolescent exposure to toxic volatile organic chemicals from E-cigarettes. Pediatrics. 2018;141:e20173557.

    Article  Google Scholar 

  15. 15.

    Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature. 2011;473:317–25.

    CAS  Article  Google Scholar 

  16. 16.

    Mukhopadhyay P, Rajesh M, Batkai S, Patel V, Kashiwaya Y, Liaudet L, et al. CB1 cannabinoid receptors promote oxidative stress and cell death in murine models of doxorubicin-induced cardiomyopathy and in human cardiomyocytes. Cardiovasc Res. 2010;85:773–84.

    CAS  Article  Google Scholar 

  17. 17.

    Bennett MR, Sinha S, Owens GK. Vascular smooth muscle cells in atherosclerosis. Circ Res. 2016;118:692–702.

    CAS  Article  Google Scholar 

  18. 18.

    Rajesh M, Mukhopadhyay P, Hasko G, Pacher P. Cannabinoid CB1 receptor inhibition decreases vascular smooth muscle migration and proliferation. Biochem Biophys Res Commun. 2008;377:1248–52.

    CAS  Article  Google Scholar 

  19. 19.

    Tiyerili V, Zimmer S, Jung S, Wassmann K, Naehle CP, Lutjohann D, et al. CB1 receptor inhibition leads to decreased vascular AT1 receptor expression, inhibition of oxidative stress and improved endothelial function. Basic Res Cardiol. 2010;105:465–77.

    CAS  Article  Google Scholar 

  20. 20.

    Jiang LS, Pu J, Han ZH, Hu LH, He B. Role of activated endocannabinoid system in regulation of cellular cholesterol metabolism in macrophages. Cardiovasc Res. 2009;81:805–13.

    CAS  Article  Google Scholar 

  21. 21.

    Han KH, Lim S, Ryu J, Lee CW, Kim Y, Kang JH, et al. CB1 and CB2 cannabinoid receptors differentially regulate the production of reactive oxygen species by macrophages. Cardiovasc Res. 2009;84:378–86.

    CAS  Article  Google Scholar 

  22. 22.

    Singla S, Sachdeva R, Mehta JL. Cannabinoids and atherosclerotic coronary heart disease. Clin Cardiol. 2012;35:329–35.

    Article  Google Scholar 

  23. 23.

    Rajesh M, Mukhopadhyay P, Batkai S, Hasko G, Liaudet L, Huffman JW, et al. CB2-receptor stimulation attenuates TNF-alpha-induced human endothelial cell activation, transendothelial migration of monocytes, and monocyte-endothelial adhesion. Am J Physiol Heart Circ Physiol. 2007;293:H2210–8.

    CAS  Article  Google Scholar 

  24. 24.

    Steffens S, Pacher P. Targeting cannabinoid receptor CB(2) in cardiovascular disorders: promises and controversies. Br J Pharmacol. 2012;167:313–23.

    CAS  Article  Google Scholar 

  25. 25.

    Nissen SE, Nicholls SJ, Wolski K, Rodes-Cabau J, Cannon CP, Deanfield JE, et al. Effect of rimonabant on progression of atherosclerosis in patients with abdominal obesity and coronary artery disease: the STRADIVARIUS randomized controlled trial. JAMA. 2008;299:1547–60.

    CAS  Article  Google Scholar 

  26. 26.

    O’Leary DH, Reuwer AQ, Nissen SE, Despres JP, Deanfield JE, Brown MW, et al. Effect of rimonabant on carotid intima-media thickness (CIMT) progression in patients with abdominal obesity and metabolic syndrome: the AUDITOR trial. Heart. 2011;97:1143–50.

    Article  Google Scholar 

  27. 27.

    Gash A, Karliner JS, Janowsky D, Lake CR. Effects of smoking marihuana on left ventricular performance and plasma norepinephrine: studies in normal men. Ann Intern Med. 1978;89:448–52.

    CAS  Article  Google Scholar 

  28. 28.

    Ponto LL, O’Leary DS, Koeppel J, Block RI, Watkins GL, Richmond JC, et al. Effect of acute marijuana on cardiovascular function and central nervous system pharmacokinetics of [(15)O]water: effect in occasional and chronic users. J Clin Pharmacol. 2004;44:751–66.

    CAS  Article  Google Scholar 

  29. 29.

    Bedi G, Cooper ZD, Haney M. Subjective, cognitive and cardiovascular dose-effect profile of nabilone and dronabinol in marijuana smokers. Addict Biol. 2013;18:872–81.

    CAS  Article  Google Scholar 

  30. 30.

    Sidney S. Cardiovascular consequences of marijuana use. J Clin Pharmacol. 2002;42:64S–70S.

    CAS  Article  Google Scholar 

  31. 31.

    Gorelick DA, Goodwin RS, Schwilke E, Schwope DM, Darwin WD, Kelly DL, et al. Tolerance to effects of high-dose oral delta9-tetrahydrocannabinol and plasma cannabinoid concentrations in male daily cannabis smokers. J Anal Toxicol. 2013;37:11–6.

    CAS  Article  Google Scholar 

  32. 32.

    Aronow WS, Cassidy J. Effect of marihuana and placebo-marihuana smoking on angina pectoris. N Engl J Med. 1974;291:65–7.

    CAS  Article  Google Scholar 

  33. 33.

    Quercioli A, Pataky Z, Vincenti G, Makoundou V, Di Marzo V, Montecucco F, et al. Elevated endocannabinoid plasma levels are associated with coronary circulatory dysfunction in obesity. Eur Heart J. 2011;32:1369–78.

    CAS  Article  Google Scholar 

  34. 34.

    Nawrot TS, Perez L, Kunzli N, Munters E, Nemery B. Public health importance of triggers of myocardial infarction: a comparative risk assessment. Lancet. 2011;377:732–40.

    Article  Google Scholar 

  35. 35.

    Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103:2805–9.

    CAS  Article  Google Scholar 

  36. 36.

    DeFilippis EM, Singh A, Divakaran S, Gupta A, Collins BL, Biery D, et al. Cocaine and marijuana use among young adults with myocardial infarction. J Am Coll Cardiol. 2018;71:2540–51.

    Article  Google Scholar 

  37. 37.

    Rana JS, Auer R, Reis JP, Sidney S. Risk of cardiovascular disease among young adults: marijuana use or the company it keeps. J Am Coll Cardiol. 2018;72:1559–60.

    Article  Google Scholar 

  38. 38.

    Desai R, Patel U, Sharma S, Amin P, Bhuva R, Patel MS, et al. Recreational marijuana use and acute myocardial infarction: insights from Nationwide Inpatient Sample in the United States. Cureus. 2017;9:e1816.

    PubMed  PubMed Central  Google Scholar 

  39. 39.

    Kalla A, Krishnamoorthy PM, Gopalakrishnan A, Figueredo VM. Cannabis use predicts risks of heart failure and cerebrovascular accidents: results from the National Inpatient Sample. J Cardiovasc Med (Hagerstown). 2018;19:480–4.

    CAS  Article  Google Scholar 

  40. 40.

    Auer R, Sidney S, Goff D, Vittinghoff E, Pletcher MJ, Allen NB, et al. Lifetime marijuana use and subclinical atherosclerosis: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Addiction. 2018;113:845–56.

    Article  Google Scholar 

  41. 41.

    Frost L, Mostofsky E, Rosenbloom JI, Mukamal KJ, Mittleman MA. Marijuana use and long-term mortality among survivors of acute myocardial infarction. Am Heart J. 2013;165:170–5.

    Article  Google Scholar 

  42. 42.

    Lorenz DR, Dutta A, Mukerji SS, Holman A, Uno H, Gabuzda D. Marijuana use impacts midlife cardiovascular events in HIV-infected men. Clin Infect Dis. 2017;65:626–35.

    CAS  Article  Google Scholar 

  43. 43.

    Fisher BA, Ghuran A, Vadamalai V, Antonios TF. Cardiovascular complications induced by cannabis smoking: a case report and review of the literature. Emerg Med J. 2005;22:679–80.

    CAS  Article  Google Scholar 

  44. 44.

    Sattout AH, Nicol MF. Cardiac arrest following cannabis use: a case report. Cases J. 2009;2:208.

    Article  Google Scholar 

  45. 45.

    Desai R, Patel U, Deshmukh A, Sachdeva R, Kumar G. Burden of arrhythmia in recreational marijuana users. Int J Cardiol. 2018;264:91–2.

    Article  Google Scholar 

  46. 46.

    Rumalla K, Reddy AY, Mittal MK. Recreational marijuana use and acute ischemic stroke: a population-based analysis of hospitalized patients in the United States. J Neurol Sci. 2016;364:191–6.

    Article  Google Scholar 

  47. 47.

    Hemachandra D, McKetin R, Cherbuin N, Anstey KJ. Heavy cannabis users at elevated risk of stroke: evidence from a general population survey. Aust N Z J Public Health. 2016;40:226–30.

    Article  Google Scholar 

  48. 48.

    Falkstedt D, Wolff V, Allebeck P, Hemmingsson T, Danielsson AK. Cannabis, tobacco, alcohol use, and the risk of early stroke: a population-based cohort study of 45 000 Swedish men. Stroke. 2017;48:265–70.

    Article  Google Scholar 

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Correspondence to Sahar Naderi.

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Moyukh Ghosh and Sahar Naderi declare no conflict of interest.

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Ghosh, M., Naderi, S. Cannabis and Cardiovascular Disease. Curr Atheroscler Rep 21, 21 (2019).

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  • Marijuana
  • Cannabis
  • Endocannabinoid system
  • Cardiovascular