Estimating the Causal Impact of Cannabis Use on Cardiovascular Events Using Double/Debiased Machine Learning Approach
Author(s)
Xiangxiang Jiang, MS1, Gang Lv, MD2, Z. Kevin Lu, PhD1.
1University of South Carolina College of Pharmacy, Columbia, SC, USA, 2The First Medical Center of Chinese PLA General Hospital, Beijing, China.
1University of South Carolina College of Pharmacy, Columbia, SC, USA, 2The First Medical Center of Chinese PLA General Hospital, Beijing, China.
OBJECTIVES: Cannabis use has been increasing across the U.S., but its potential impact on cardiovascular outcomes remains insufficiently understood. This study aims to investigate the association between cannabis use and the risk of coronary heart disease (CHD), myocardial infarction (MI), and stroke using a double/debiased machine learning (DML) approach.
METHODS: We utilized data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS). Cannabis use was identified by a self-reported survey question and categorized into nonuse, frequent use (1-29 days/month), and daily use (30 days/month). Outcomes included CHD, MI, and stroke. Covariates were selected based on the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework. A total of 82 covariates were included. We applied the DML approach to estimate the causal effect of cannabis use on cardiovascular risk.
RESULTS: A total of 18,346 individuals were included, with 18.33% of them using cannabis. Cannabis use was not significantly associated with increased cardiovascular risk. However, there is a significantly higher combined cardiovascular risk (Effect=1.048, 95% CI: 1.009-1.089) among Black individuals, driven largely by increased MI risk (Effect=1.037, 95% CI: 1.010-1.064). This relationship was observed among frequent cannabis users as well. Furthermore, among younger adults (men <55, women <65), cannabis use and frequent use were significantly associated with elevated composite cardiovascular risk (Effect=1.010, P=0.023; Effect=1.013, P=0.007, respectively).
CONCLUSIONS: While overall cannabis use was not linked to higher cardiovascular risk, subgroup analyses showed elevated risk among Black individuals and younger adults, especially with frequent use. These findings underscore the need to consider racial and demographic disparities when evaluating cannabis-related health effects. Public health messaging should be tailored for vulnerable populations, and clinicians should monitor frequent users. Longitudinal research is needed to clarify causal pathways and long-term cardiovascular outcomes as cannabis use continues to increase nationwide.
METHODS: We utilized data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS). Cannabis use was identified by a self-reported survey question and categorized into nonuse, frequent use (1-29 days/month), and daily use (30 days/month). Outcomes included CHD, MI, and stroke. Covariates were selected based on the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework. A total of 82 covariates were included. We applied the DML approach to estimate the causal effect of cannabis use on cardiovascular risk.
RESULTS: A total of 18,346 individuals were included, with 18.33% of them using cannabis. Cannabis use was not significantly associated with increased cardiovascular risk. However, there is a significantly higher combined cardiovascular risk (Effect=1.048, 95% CI: 1.009-1.089) among Black individuals, driven largely by increased MI risk (Effect=1.037, 95% CI: 1.010-1.064). This relationship was observed among frequent cannabis users as well. Furthermore, among younger adults (men <55, women <65), cannabis use and frequent use were significantly associated with elevated composite cardiovascular risk (Effect=1.010, P=0.023; Effect=1.013, P=0.007, respectively).
CONCLUSIONS: While overall cannabis use was not linked to higher cardiovascular risk, subgroup analyses showed elevated risk among Black individuals and younger adults, especially with frequent use. These findings underscore the need to consider racial and demographic disparities when evaluating cannabis-related health effects. Public health messaging should be tailored for vulnerable populations, and clinicians should monitor frequent users. Longitudinal research is needed to clarify causal pathways and long-term cardiovascular outcomes as cannabis use continues to increase nationwide.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
RWD76
Topic
Epidemiology & Public Health, Health Policy & Regulatory, Real World Data & Information Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)