On June 17, 2025, the journal Heart published a large meta-analysis titled “Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis” (Storck et al., 2025). This study reviewed 24 observational studies conducted between 2016 and 2023, analyzing data from nearly 200 million adults worldwide.
The results were eye-opening. Cannabis use was associated with:
- A 29% higher risk of acute coronary syndrome (heart attack)
- A 20% higher risk of stroke
- A more than twofold increased risk of cardiovascular death
And here’s the kicker: the risk was not limited to smoking. Edible users showed similar cardiovascular drawbacks.
If you rely on cannabis for chronic pain, anxiety, sleep, or focus, these findings might feel unsettling. After all, many people turn to cannabis because it seems like a safer alternative to opioids, alcohol, or prescription sleep medications.
So how do we make sense of this? What does this study really mean for everyday users, and how can we keep the medical benefits of cannabis while minimizing the risks?
This post will break down the study, examine why THC itself—not just smoke—is implicated, and then explore practical alternatives for the most common medical reasons people use cannabis.
The Study: Key Findings
You can access the full paper on PubMed here or directly through the Heart journal here.
What the Meta-Analysis Found
- Acute coronary syndrome (including heart attack): Risk ratio 1.29
- Stroke: Risk ratio 1.20
- Cardiovascular death: Risk ratio 2.10
These associations remained consistent even when limiting the analysis to cohort studies, meaning the findings are relatively robust.
Why It Matters
The results suggest that cannabis use is not a benign choice for heart health. For decades, the debate focused on whether the act of smoking was the problem. While inhalation carries risks of its own, this study shows that THC itself may negatively impact cardiovascular function, regardless of how it is consumed.
Why Cannabis Affects the Heart
1. Vascular Effects of THC
- THC can cause vasoconstriction, narrowing blood vessels.
- It can promote inflammation and oxidative stress.
- It may impair the endothelium (the lining of blood vessels), which is an early marker for atherosclerosis and heart disease.
2. Impact on Blood Pressure and Rhythm
- THC has been shown to cause temporary spikes in heart rate and blood pressure.
- In vulnerable individuals, it can trigger arrhythmias or increase cardiac workload.
3. Dose and Delivery
- Edibles deliver larger and longer-lasting doses of THC than inhalation, which may stress the cardiovascular system even more.
- Smoking and vaping add lung-related risks, but the heart impact is not limited to smoke.
4. Supporting Research
A smaller UCSF study (2025) found endothelial dysfunction in cannabis users, regardless of smoking or edible use. Vascular function declined 42% in smokers and 56% in edible users, compared with non-users (People.com summary).
What This Doesn’t Mean
- It doesn’t mean every cannabis user is doomed to heart disease. These are relative risks, not guarantees.
- The data is observational. That means it shows associations, not direct causation. Lifestyle factors (diet, activity, stress) still play a role.
- The study doesn’t mean cannabis has no medical value—it highlights the need for caution and smarter use.
Why People Still Use Cannabis
Cannabis remains a crucial tool for many medical conditions:
- Chronic pain: Neuropathic pain, arthritis, injury recovery
- Anxiety and PTSD: A calming effect that can feel immediate
- Sleep: Help for insomnia or sleep disruptions
- Appetite stimulation: Especially for patients with HIV/AIDS or cancer
- Focus and creativity: Anecdotally, some use it to stay “in the zone”
Given how effective cannabis can be in these areas, dismissing it outright is not realistic—or compassionate. Instead, the question becomes: how do we preserve the benefits while reducing the risks?
Alternatives and Complements to Cannabis
1. Chronic Pain
Alternatives:
- CBD creams or patches for localized relief
- Low-dose naltrexone (LDN) (investigated for anti-inflammatory properties)
- Physical therapy, mobility drills, acupuncture, massage
- Turmeric, magnesium, omega-3s
When to Use Cannabis: During acute flare-ups where other methods are insufficient.
2. Anxiety
Alternatives:
- CBD isolate or broad-spectrum products (THC-free)
- Ashwagandha, L-theanine, or magnesium glycinate
- Breathing techniques such as box breathing or 4-7-8 breathing
- Cognitive Behavioral Therapy (CBT) or journaling
Caution: High-THC strains can worsen anxiety long-term, even if they feel calming in the moment.
3. Sleep
Alternatives:
- Magnesium glycinate or glycine before bed
- Low-dose melatonin (0.5 mg)—less is often more effective
- CBN (cannabinol) paired with CBD
- Sleep hygiene: dim lights, consistent routine, screen cut-off, stretching
When to Use Cannabis: On nights when pain or anxiety disrupts normal sleep strategies.
4. Focus and ADHD Symptoms
Alternatives:
- L-tyrosine or Rhodiola rosea for dopamine and energy support
- Lion’s Mane mushroom for neuroprotection and focus
- Pomodoro technique or body doubling to sustain attention
- Cold exposure plus light cardio for a natural focus boost
When to Use Cannabis: Occasionally for creative tasks, not daily productivity.
What About CBD?
Unlike THC, CBD does not appear to carry the same cardiovascular risks. Early studies suggest it may:
- Reduce inflammation
- Lower blood pressure slightly
- Protect blood vessels
But not all CBD is equal. Many products contain trace THC or contaminants. Look for:
- Third-party lab testing (Certificate of Analysis)
- Broad-spectrum or isolate formulations if you want zero THC
- Transparent brands that publish lab results
Practical Harm Reduction Strategies
If you continue to use cannabis, here are evidence-based ways to reduce risk:
- Avoid smoking and vaping; choose tinctures, capsules, or edibles instead (though still with caution).
- Use the lowest effective THC dose; microdosing may deliver benefits without heavy cardiovascular load.
- Stay physically active; cardiovascular exercise counteracts many vascular risks.
- Pre-plan snacks if munchies are a factor; choose heart-healthy options instead of high-sodium junk food.
- Do not mix cannabis with tobacco or excessive alcohol, both of which compound cardiovascular risk.
- Consult your doctor, especially if you have high blood pressure, arrhythmias, or family history of heart disease.
Final Thoughts: A Balanced Approach
The Heart study is not a call to abandon cannabis altogether. It is a reminder that THC is not risk-free—and that our choices around dose, frequency, and lifestyle matter.
If cannabis helps you function, sleep, or manage pain, it still has a place. But it should be part of a toolkit, not the only tool. CBD, supplements, lifestyle adjustments, and behavioral strategies can help balance the scales.
In short:
- Cannabis is powerful.
- THC carries real cardiovascular risks.
- Harm reduction is possible, and balance is key.
The best approach is to use cannabis intentionally and sparingly, while building a healthier foundation around it.
References:
- Storck C, et al. Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis. Heart. 2025; heartjnl-2024-325429. Published online June 17, 2025. DOI: 10.1136/heartjnl-2024-325429
- PubMed entry
- UCSF endothelial dysfunction study summary via People.com
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