Adults who used cannabis between one and five days per month faced a 40% higher odds of reporting a previous stroke compared to non-users, according to a new study of nearly 450,000 U.S. adults. The findings reveal a complex link between cannabis and cardiovascular health that challenges long-held assumptions among health professionals.
Tulane University Research Challenges Cannabis Assumptions
New research analyzing survey responses from 442,906 participants in the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System reveals that cannabis use is tied to elevated risks of cardiovascular disease and stroke. The findings, encompassing data collected between 2020 and 2024, are scheduled for presentation at the Scientific Sessions 2026 in Chicago, Illinois, running November 6–9.
Led by researchers at Tulane University, the investigation aimed to provide an updated, large-scale picture of the cardiovascular effects of cannabis use as commercial availability and recreational legalization expand across the United States. Earlier research cited by the study authors indicates that past-month cannabis use among U.S. adults surged from 1 in 10 in 2020 to 1 in 6 in 2024, representing a 51% increase over four years. According to Dr. Kristen “Nicke” Worth, a telehealth medical adviser at NuggMD and Ohio-based physician specializing in medical marijuana evaluations, the outcomes are worrisome, particularly regarding stroke events. The study is limited by its cross-sectional design, which cannot establish that cannabis use causes heart disease, as well as the subjective nature of self-reported diagnoses and product use, and a lack of data regarding product potency.
Occasional Users Face Higher Stroke Odds Than Heavy Users
The analysis uncovered unexpected patterns regarding the frequency of consumption. While investigators initially anticipated that cardiovascular risks would scale upward in a straightforward, dose-dependent manner with heavier use, both low-frequency and high-frequency consumers demonstrated elevated risks.
Compared to individuals reporting no recent cannabis use, participants using the substance one to five days per month experienced 23% higher odds of reporting a history of cardiovascular disease. Those using cannabis 16 to 30 days per month showed 21% higher odds. Individuals using cannabis six to 15 days per month were classified as moderate users.
The strongest associations centered on strokes. Low-frequency users exhibited 40% higher odds of a reported previous stroke, while heavy users showed 25% higher odds. Meanwhile, researchers found no statistically significant link between how frequently participants used cannabis and their likelihood of reporting a previous heart attack.
Shifting Perspectives on Cardiovascular Risk Factors
The findings complicate historical assessments of cannabis use, particularly among patients who also consume tobacco. Historically, health evaluations have tended to treat marijuana as a harmless co-factor when assessing individuals who also smoke tobacco, a perspective highlighted by Robert L. Page II, an American Heart Association volunteer expert and clinical pharmacy professor at the University of Colorado who did not participate in the research.
In patients who use both, cannabis has always been considered an innocent bystander; however, this is not the case
Page emphasized that cannabis is beginning to emerge as a major contributor to premature heart disease in both younger and older adults. He recommended that doctors incorporate discussions about marijuana into routine heart health screenings just as they do for tobacco, and suggested that individuals with pre-existing conditions such as high blood pressure, diabetes, past tobacco use, or a previous stroke bring up the subject during their upcoming medical appointments. Anyone using cannabis, whether medically or recreationally, should consult a qualified healthcare professional to discuss their cardiovascular history, risk factors, medications, and potential treatment alternatives.