08 Nov Cannabis Use Disorder Linked to Higher Risk of Heart Attack, Stroke and Heart Failure
Health Notice: This interview discusses research findings and is not medical advice. If you are concerned about your cannabis use, talk with your healthcare provider or call the SAMHSA National Helpline at 1-800-662-4357 (free, confidential, 24/7). If you are in crisis, call or text 988. Call 911 right away for chest pain or pressure, shortness of breath, sudden weakness or numbness on one side of the body, trouble speaking, or a sudden severe headache.
Prof. Cuomo
MedicalResearch.com Interview with:
Raphael E. Cuomo, PhD, MPH, CPH, FRSPH
Associate Adjunct Professor, Anesthesiology
University of California, San Diego
MedicalResearch.com: What is the background for this study, and why focus on documented cannabis use disorder?
Response: Previous research has raised concerns about cannabis and cardiovascular disease. I wanted to examine both disease onset and survival after diagnosis. Documented cannabis use disorder gives us a defined clinical population to study, as medical records often lack reliable information about cannabis consumption.
MedicalResearch.com: How was the study done, and what is Epic Cosmos?
Response: Epic Cosmos brings together medical records from many health systems, allowing researchers to examine diagnoses and outcomes over time. We identified approximately 94.7 million eligible patients, then analyzed these patients to examine first recorded cardiovascular events. Separate analyses examined mortality after cardiovascular diagnoses. The models accounted for measured differences such as age, smoking, hypertension, and diabetes.
MedicalResearch.com: What are the main findings, and what do the hazard ratios mean?
Response: The primary adjusted analyses found approximately 41% higher hazard of heart attack, 55% higher hazard of stroke and 37% higher hazard of heart failure among patients with documented cannabis use disorder. A hazard ratio of 1.4 means roughly a 40% higher estimated event rate during follow-up.
MedicalResearch.com: How should readers interpret the mortality findings?
Response: The primary analyses did not show a clear increase in mortality. A higher mortality signal one to three years after stroke appeared in one exploratory model.
MedicalResearch.com: What is Cuomo’s Paradox, and what might explain it?
Response: The risk-survival paradox, more popularly known as Cuomo’s Paradox, describes how a factor associated with developing disease can have a weaker or reversed relationship with survival after diagnosis. Here, the mortality estimates were smaller, without a demonstrated survival benefit. Differences in age, disease severity, diagnosis and follow-up could contribute.
MedicalResearch.com: Why was the heart failure finding less consistent?
Response: Heart failure encompasses varied conditions, and differences in how it is diagnosed and recorded may make the findings more sensitive to diagnostic criteria. Restricting analyses to complete records also produces a smaller, different patient group.
MedicalResearch.com: How might missing information about cannabis use and other diagnoses affect the results?
Response: Without information on dose, potency and route, we cannot identify which patterns of cannabis use account for the findings. Although we adjusted for recorded smoking status, detailed smoking histories were unavailable. These unmeasured differences could strengthen or weaken the estimated associations.
MedicalResearch.com: What should clinicians take away from your report?
Response: A documented cannabis use disorder should prompt a review of blood pressure, cholesterol, diabetes, tobacco use and other cardiovascular risks. It is also an opportunity to offer treatment for the disorder and address barriers to care.
MedicalResearch.com: What should people who use cannabis take away?
Response: People with cannabis use disorder should discuss both their substance use and cardiovascular health with their clinician. Difficulty controlling use is a reason to seek support. For people who use cannabis occasionally, this study cannot quantify their individual risk or identify a safe dose or product. The mortality findings provide no basis for viewing cannabis as protective after a cardiovascular event.
MedicalResearch.com: What further research is needed?
Response: We need prospective studies that measure frequency, dose, potency and route, while capturing tobacco exposure, other substances and psychiatric conditions. Better information on disease severity, treatment, and follow-up would help clarify the survival findings. A particularly important question is whether reducing or stopping cannabis use changes cardiovascular outcomes.
MedicalResearch.com: Do you have any disclosures or funding sources to report?
Response: I have no conflicts of interest. I received no funding from any source for this study.
For more information, see the CDC (Centers for Disease Control and Prevention) page on cannabis and heart health. For a broader overview of cannabis and cardiovascular care, see this MedicalResearch.com interview on why cardiologists should screen patients for marijuana use.
Citation: Cuomo RE. Cannabis Use Disorder and Cardiovascular Events and Mortality in a Multi-Health-System Electronic Health Record Cohort. SN Comprehensive Clinical Medicine. 2026;8:610. https://doi.org/10.1007/s42399-026-02866-y
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Last Updated on November 8, 2026 by Marie Benz MD FAAD