Association of cannabis use with major cardiovascular and cerebrovascular events after surgery or interventional procedures

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Noncardiac surgery or interventional procedures (n=288923). Intervention: Nonmedical cannabis use vs. No cannabis use. Primary outcome: MACCE (ischemic stroke, cardiac arrest, acute heart failure, myocardial infarction, or revascularization within 1 year) (OR 1.26, 95% CI 1.05-1.51, p=.02).

Q: What does this research mean for the field?

Cannabis use disorder is associated with an increased risk of 1-year major adverse cardiovascular and cerebrovascular events following noncardiac surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Sarah Ashrafian; Elena Ahrens; Luca J. Wachtendorf; Ricardo Munoz‐Acuna; Denys Shay; Aiman Suleiman; Simone Redaelli; Dario von Wedel; Guanqing Chen; Georg Wolff; Kevin P. Hill; Maximilian S. Schaefer

doi:10.1111/ajad.70029

April 9, 2025American Journal on AddictionsOpen Access

Association of cannabis use with major cardiovascular and cerebrovascular events after surgery or interventional procedures

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Key result

Cannabis use disorder is linked to a ~26% higher 1-year MACCE risk after noncardiac surgery.

OR 1.26
95% CI 1.05-1.51
P=.02
n=288,923

Why the study?

Does nonmedical cannabis use increase the risk of MACCE in adult patients undergoing noncardiac surgery?

Key Points

To assess the association between nonmedical cannabis use and major adverse cardiovascular and cerebrovascular events within one year following noncardiac surgery.
Retrospective cohort analysis of 288,923 adult patients undergoing noncardiac surgery between 2008 and 2020 at a tertiary academic hospital in Massachusetts, United States.
Exposure was classified as self-reported recreational cannabis use or a clinical diagnosis of cannabis use disorder.
The primary endpoint was MACCE within 1 year, defined as ischemic stroke, cardiac arrest, acute heart failure, myocardial infarction, or revascularization, stratified by Revised Cardiac Risk Index (RCRI) score.
Patients diagnosed with cannabis use disorder had significantly higher odds of 1-year MACCE compared to non-users (adjusted OR 1.26; 95% CI, 1.05–1.51; p = .02).
Recreational cannabis use was significantly associated with MACCE among high cardiac risk patients in RCRI class III/IV (adjusted OR 1.41; 95% CI, 1.15–1.74; p = .001).
Recreational cannabis use showed no statistically significant association with MACCE among low cardiac risk patients in RCRI class I/II (adjusted OR 0.87; 95% CI, 0.75–1.02; p = .09).

Study Design

Type

Cohort (n=288,923)

Multicenter

No

Structured PICO

Does nonmedical cannabis use increase the risk of MACCE in adult patients undergoing noncardiac surgery?

P

Population

288,923 adult patients undergoing noncardiac surgery between 2008 and 2020 at a single tertiary academic hospital in the US, followed for 1 year.

E

Exposure

Nonmedical use of cannabis (ongoing self-reported recreational use or diagnosis of cannabis use disorder)

C

Comparator

Patients without cannabis use (implied)

O

Outcome

Major adverse cardiovascular or cerebrovascular events (MACCE), defined as ischemic stroke, cardiac arrest, acute heart failure, myocardial infarction, or revascularization within 1 yearcomposite

Main Result

Odds Ratio: 1.26 (95% CI 1.05–1.51)

p-value: p=.02

Implication

Cannabis use disorder and recreational cannabis use in high-risk patients are associated with an increased risk of major cardiovascular and cerebrovascular events within 1 year after noncardiac surgery.

Discussion

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Cite This Study

Ashrafian et al. (2025) conducted a cohort in Noncardiac surgery or interventional procedures (n=288,923). Nonmedical cannabis use vs. No cannabis use was evaluated on MACCE (ischemic stroke, cardiac arrest, acute heart failure, myocardial infarction, or revascularization within 1 year) (OR 1.26, 95% CI 1.05-1.51, p=.02). A diagnosis of cannabis use disorder was associated with an increased risk of MACCE within 1 year after noncardiac surgery (adjusted OR 1.26; 95% CI 1.05-1.51; p=0.02).

synapsesocial.com/papers/6a8221fde9dda39dfc46bf39 https://doi.org/10.1111/ajad.70029

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Association of cannabis use with major cardiovascular and cerebrovascular events after surgery or interventional procedures

Key Points

Study Design

Structured PICO

Main Result

Implication

Discussion

Cite This Study

Association of cannabis use with major cardiovascular and cerebrovascular events after surgery or interventional procedures

Key Points

Study Design

Structured PICO

Main Result

Implication

Discussion

Cite This Study

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