By Michael H. Crawford, MD, Editor
SYNOPSIS: Admitted cannabis use was associated with an increase in the pooled risk of atherosclerosis score in a graded fashion based on the frequency of use, which was consistent across subgroups based on the presence of hypertension, obesity, and hyperlipidemia.
SOURCE: Skipina TM, Patel N, Upadhya B, Soliman EZ. Relation of cannabis use to elevated atherosclerotic cardiovascular disease risk score. Am J Cardiol 2022;165:46-50.
Little is known about the relationship of cannabis use to traditional risk factors for atherosclerotic cardiovascular disease (ASCVD). Skipina et al studied this relationship using National Health and Nutrition Examination Survey (NHANES) data from 2011 through 2018. The authors excluded those younger than age 18 years, those with a history of ASCVD, or those who were missing data regarding cannabis use.
Ever cannabis users were defined as those who used at least once. Current users were defined as those who used at least once a month for the last 12 months. This group was subdivided into light users (use four days or fewer per month) and heavy users (use five or more days per month).
To create a composite risk of ASCVD over 10 years, the authors used the American College of Cardiology/American Heart Association (ACC/AHA) pooled risk equation score, divided into low risk (< 5%), borderline risk (5% to 7.4%), intermediate risk (7.5% to < 20%), and high risk (≥ 20%). After exclusions, there were 7,159 participants (mean age = 38 years; 49% men, 62% white).
About 64% of subjects were considered ever cannabis users and recorded a 60% increased odds ratio (OR) of a high-risk ASCVD score (1.60, 95% CI, 1.04-2.45; P = 0.03). There was a dose response relationship between more cannabis use and a high-risk ASCVD score: light users (OR, 1.79; 95% CI, 1.10-2.92) and heavy users (OR, 1.87; 95% CI, 1.16-3.01). Subgroup analyses based on race, sex, hypertension, obesity, and hyperlipidemia showed consistency of the results. The authors concluded cannabis use is associated with higher ASCVD risk scores.
COMMENTARY
Cannabis is a common drug of abuse in the United States, and expanding legalization movement likely will drive further use. Thus, it is important to understand the risks of cannabis use. Since they excluded subjects with known ASCVD, Skipina et al focused on prevention, studying the relationship between self-reported cannabis use and the ACC/AHA pooled risk of ASCVD score. Not only was there a strong dose-related association, but adjusting for traditional ASCVD risk factors did not alter this association.
It also is noteworthy that this study included a relatively young population. It appears ASCVD is not just a disease of the elderly, as incidence rates in young and middle-aged individuals are going up for unclear reasons. How cannabis raises the risk for ASCVD was not apparent in this study nor in the available literature. Complicating matters is possible tobacco and other recreational drug use among cannabis users. Accordingly, it is important to address other risk factors among cannabis users to try to lower their overall ASCVD risk.
The major strength of this study was the large population size, which also was racially representative of the U.S. population. Still, there were some weaknesses. The design was cross-sectional, which might lead to residual biases. It was based on self-reported data, so cannabis use could have been underestimated. Also, cannabis is a diverse genus that comes in a wide variety of potency. There was no information on dose, route of administration, type, or whether there were periods of abstinence.
Despite these weaknesses, the data suggest cannabis use either promotes other risky behavior, such as tobacco smoking, or it directly and adversely affects the vasculature — or both. By reducing or eliminating cannabis use or addressing other ASCVD risk factors among these patients, perhaps the rising tide of ASCVD among younger individuals can be stemmed.
Admitted cannabis use was associated with an increase in the pooled risk of atherosclerosis score in a graded fashion based on the frequency of use, which was consistent across subgroups based on the presence of hypertension, obesity, and hyperlipidemia.
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