Cannabis users face sixfold higher risk of heart disease, study warns
With cannabis use on the rise in Kenya, public health experts stress the need for awareness campaigns and targeted interventions to mitigate its impact on society. Addressing the risks associated with marijuana use, particularly among the youth, remains a crucial step in safeguarding public health and well-being.
A study has found that cannabis users under 50 face a sixfold higher risk of heart attacks, alongside increased chances of stroke, heart failure, and cardiovascular death. Previous research also links daily marijuana use to coronary artery disease.
In Kenya, the burden of non-communicable diseases (NCDs) is rising. A NACADA report shows that 93,430 youths (2.7%) use cannabis, while the Ministry of Health reports that NCDs account for 50% of hospital admissions.
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With heart risks escalating, Cannabis is the most cultivated, trafficked, and abused illicit drug worldwide, accounting for half of all drug seizures across the globe, as noted by the World Health Organisation.
These seizures occur in nearly every country, highlighting its widespread presence. An estimated 147 million people, or 2.5% of the global population, use cannabis annually, far exceeding the 0.2% who consume cocaine or opiates. In recent years, cannabis use has increased at a faster rate than both cocaine and opiate abuse.
The findings from the study involving over 4.6 million individuals were published in JACC Advances, along with a meta-analysis of 12 previously conducted studies.
The meta-analysis, the most extensive pooled study to date on cannabis use and heart attacks, revealed a 50% higher risk among users.
Dr Ibrahim Kamel, a clinical instructor at the Boston University Chobanian & Avedisian School of Medicine and an internal medicine resident at St Elizabeth Medical Centre in Boston and lead author of the study, emphasised that clinicians should include cannabis use in their assessments of patients' cardiovascular risk, just as they do with cigarette smoking. He also stressed the need for policy measures to ensure that cannabis users are aware of the associated health risks.
The findings reveal that over an average follow-up period of more than three years, cannabis users faced a significantly higher risk of cardiovascular events. Specifically, they were over six times more likely to experience a heart attack, four times more likely to suffer an ischaemic stroke, twice as likely to develop heart failure, and three times more likely to face cardiovascular-related death, heart attack, or stroke.
Notably, all participants in the study were under the age of 50 and had no prior cardiovascular conditions, with healthy blood pressure, low-density lipoprotein (LDL) cholesterol levels, and no history of diabetes, tobacco use, or coronary artery disease.
In the meta-analysis, researchers combined data from 12 previously published studies, involving a total of more than 75 million individuals. The studies were rated as having moderate to good methodological quality. Of these, 10 were conducted in the United States, while one took place in Canada and another in India. Although some studies lacked specific age data, those that included this information reported an average participant age of 41, indicating that the sample primarily consisted of a relatively young population.
The exact mechanisms by which marijuana or its components affect the cardiovascular system remain unclear. However, researchers suggest that cannabis may disrupt heart rhythm regulation, increase oxygen demand in the heart muscle, and contribute to endothelial dysfunction, making it more difficult for blood vessels to relax and expand, thereby impairing blood flow.
One study within the meta-analysis found that the risk of a heart attack peaked approximately one hour after marijuana consumption.
When analysed individually, seven of the studies demonstrated a significant positive link between cannabis use and heart attack risk, four found no notable difference, and one indicated a slightly negative association. However, when researchers pooled and analysed the data collectively, they identified a strong overall association, with active cannabis users being 1.5 times more likely to experience a heart attack than non-users.
A study presented at the American College of Cardiology's Annual Scientific Session in 2023 found that daily marijuana users were approximately 34% more likely to develop coronary artery disease (CAD) compared to non-users.
The research, led by Dr Ishan Paranjpe, a resident physician at Stanford University, utilised data from the All of Us Research Programme, which included information from over 175,000 participants. The study categorised participants based on their marijuana use: daily users, less frequent users, and non-users.
After adjusting for various factors, including age, sex, and major cardiovascular risk determinants, the findings indicated a significant association between daily cannabis use and an increased risk of CAD.
Dr Paranjpe noted that the study suggests a dose-response relationship, where more frequent cannabis use correlates with a higher risk of CAD. He emphasised that these findings highlight potential harms of cannabis use that may not have been previously recognised, suggesting that individuals should consider these risks.
The study also employed Mendelian randomisation analyses, which supported a causal relationship between cannabis use disorder and the development of CAD. These findings underscore the importance for healthcare providers to discuss cannabis use with their patients and consider its potential impact on cardiovascular health.
A NACADA survey reveals that 518,807 Kenyans aged 15 to 65 are currently using cannabis, representing a national prevalence rate of 1.9 per cent. According to the Status of Drugs and Substance Use (DSU) in Kenya, 2022 report, the majority of users—475,770—are male, while 43,037 are female.
Cannabis use remains a growing concern in both rural and urban areas, with increasing accessibility and changing social dynamics contributing to its widespread consumption.
Marijuana is commonly smoked in joints, but other forms such as edibles and infused beverages are also gaining popularity. Studies indicate that usage is more prevalent among men, the unemployed, and urban residents, though rural areas are also experiencing a surge.
The most affected age group is between 18 and 25, making young adults particularly vulnerable to its effects. Alongside cannabis, other substances such as inhalants, narcotics, and prescription drugs are also widely abused, compounding social issues such as poverty, peer pressure, and stigmatisation.
The WHO notes that the health impacts of cannabis use are significant. Research has linked its consumption to an increased risk of cardiovascular diseases, including heart attacks, strokes, and hypertension.
Smoking marijuana has also been associated with respiratory complications such as chronic bronchitis, lung inflammation, and heightened susceptibility to infections.
Additionally, prolonged use has been shown to affect mental health, increasing the risk of anxiety, depression, psychosis, and schizophrenia, particularly among young users. Cognitive functions such as memory, attention span, and decision-making skills may also be impaired, especially in adolescents and frequent users.
Despite the perception that marijuana is not addictive, cannabis use disorder is a recognised condition, with withdrawal symptoms such as irritability, insomnia, and cravings. There is also growing evidence suggesting that prolonged cannabis consumption may negatively affect fertility in both men and women.
With cannabis use on the rise in Kenya, public health experts stress the need for awareness campaigns and targeted interventions to mitigate its impact on society. Addressing the risks associated with marijuana use, particularly among the youth, remains a crucial step in safeguarding public health and well-being.
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