Occasional Cannabis Use Linked to 40% Higher Odds of Stroke

Adults who reported using cannabis on as few as 1 to 5 days per month had higher odds of reporting a history of cardiovascular disease (CVD), with the strongest association seen for stroke, according to new preliminary research to be presented at the American Heart Association (AHA) Scientific Sessions 2026.¹

The findings come from a poster abstract that has not yet been peer reviewed and will be presented at the meeting, held November 6 to 9 in Chicago, Illinois. The investigators said cannabis use should be considered when assessing cardiovascular risk and included in counseling on heart disease and stroke prevention.

Stroke Odds 40% Higher With Low-Frequency Use

The researchers pooled 2020-2024 data from the Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey, for 442,906 US adults with an average age of 49 years; about half were women. Only states that included the survey's optional marijuana module were eligible, with 16 to 24 states participating each year.

Participants reported how many days in the past month they had used cannabis, whether smoked, vaped, or eaten. Use was categorized as none, low frequency (1-5 days), moderate frequency (6-15 days), or heavy frequency (16-30 days). Participants also reported whether they had ever been diagnosed with a heart attack, heart disease, heart-related chest pain, or stroke. Analyses were adjusted for demographics, tobacco smoking, alcohol use, obesity, diabetes, chronic kidney disease, physical inactivity, education, and income.

Compared with no use, low-frequency use was associated with 23% higher odds of reporting a history of CVD, and heavy use was associated with 21% higher odds. For stroke, low-frequency use was associated with 40% higher odds and heavy use with 25% higher odds. There was no statistically significant association between frequency of use and heart attack. The AHA release did not report results for the moderate-frequency group or provide CIs.

"We were surprised to find that the link between cannabis use and cardiovascular disease was not straightforward," said study author Aabha Divya, MBBS, MCh, an assistant professor in the division of cardiothoracic surgery at Tulane University School of Medicine, in a statement. "We expected that the chances of heart disease would gradually rise as people used cannabis more often, but that wasn't the case. Both low-use and heavy-use groups had higher odds of developing heart disease."

No Dose-Response Pattern, Unlike 2016-2020 Data

The lack of a stepwise pattern contrasts with an earlier analysis of 2016-2020 BRFSS data published in the Journal of the American Heart Association. That study of 434,104 adults from 27 states and 2 territories found that heavier use was associated with higher odds of adverse outcomes. Daily use was associated with higher odds of stroke (adjusted OR, 1.42; 95% CI, 1.20-1.68) and myocardial infarction (adjusted OR, 1.25; 95% CI, 1.07-1.46).²

Divya said the team set out to build on that work as recreational legalization and commercial cannabis products have expanded, noting that earlier results on cardiovascular effects have not been consistent. She pointed to prior research indicating that 1 in 6 US adults reported past-month cannabis use in 2024, up from 1 in 10 in 2020.¹

The study has several limitations. Its cross-sectional design cannot establish that cannabis use causes heart disease, and both cannabis use and diagnoses were self-reported. Data on product potency and amount consumed were unavailable, and the analysis did not cover all states. People may also have cut back or quit after a diagnosis, so the no-recent-use group could include former users.

Robert L. Page II, PharmD, MSPH, chair of the writing group for AHA's 2020 cannabis scientific statement, who was not involved in the study, said many patients who use cannabis also smoke tobacco, which clouds assessment of atherosclerotic CVD risk, but that cannabis should not be considered an innocent bystander.

“Overall, cannabis is beginning to emerge as a major contributor to premature heart disease in young and older adults, which can lead to serious cardiovascular events,” he said in a statement. “To this end, clinicians should be addressing cannabis use with their patients as they would tobacco use when considering the risk of cardiovascular disease.”

References

1. Cannabis use linked to an increased risk of cardiovascular disease, especially strokes. News release. American Heart Association. November 2, 2026. Accessed November 2, 2026. https://newsroom.heart.org/news/cannabis-use-linked-to-an-increased-risk-of-cardiovascular-disease-especially-strokes
2. Jeffers AM, Glantz S, Byers AL, Keyhani S. Association of Cannabis Use With Cardiovascular Outcomes Among US Adults. J Am Heart Assoc. 2024;13(5):e030178. doi:10.1161/JAHA.123.030178