Publications

Background

Marijuana use is increasing in the United States, and its effect on cardiovascular health is unknown.

Purpose

To review harms and benefits of marijuana use in relation to cardiovascular risk factors and clinical outcomes.

Data Sources

PubMed, MEDLINE, EMBASE, PsycINFO, and the Cochrane Library between 1 January 1975 and 30 September 2017.

Study Selection

Observational studies that were published in English, enrolled adults using any form of marijuana, and reported on vascular risk factors (hyperglycemia, diabetes, dyslipidemia, and obesity) or on outcomes (stroke, myocardial infarction, cardiovascular mortality, and all-cause mortality in cardiovascular cohorts).

Data Extraction

Study characteristics and quality were assessed by 4 reviewers independently; strength of evidence for each outcome was graded by consensus.

Data Synthesis

13 and 11 studies examined associations between marijuana use and cardiovascular risk factors and clinical outcomes, respectively. Although 6 studies suggested a metabolic benefit from marijuana use, they were based on cross-sectional designs and were not supported by prospective studies. Evidence examining the effect of marijuana on diabetes, dyslipidemia, acute myocardial infarction, stroke, or cardiovascular and all-cause mortality was insufficient. Although the current literature includes several long-term prospective studies, they are limited by recall bias, inadequate exposure assessment, minimal marijuana exposure, and a predominance of low-risk cohorts.

Limitation

Poor- or moderate-quality data, inadequate assessment of marijuana exposure and minimal exposure in the populations studied, and variation in study design.

Conclusion

Evidence examining the effect of marijuana on cardiovascular risk factors and outcomes, including stroke and myocardial infarction, is insufficient.

Primary Funding Source

National Heart, Lung, and Blood Institute. (PROSPERO: CRD42016051297).