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The relationship between cannabis and cardiovascular disease: clearing the haze

Nature Reviews Cardiology volume 22, pages 467–481 (2025)Cite this article

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Abstract

Cannabis has been consumed for centuries, but global regulatory changes over the past three decades have increased the availability and consumption of cannabis. Cannabinoids are touted to have therapeutic potential for many diseases and could be a replacement for opioids for analgesia and sedation. However, cannabinoids can cause substantial adverse cardiovascular events that would mitigate any potential benefit. The endocannabinoid system regulates mood, satiety and memory, and modulates the cardiovascular system. The link between cannabinoids and cardiovascular disease, which used to be limited to evidence from preclinical studies, case reports and case series, is now evident in epidemiological studies. Cannabinoids adversely affect the cardiovascular system, causing myocardial infarction, cerebrovascular accidents, arrhythmia and heart failure. The effects of novel cannabinoids are unknown, and synthetic cannabinoids have the potential to cause even more substantial harm than traditional cannabinoids. Therefore, with the increasing availability and use of cannabis, the acute and chronic effects of this drug are becoming apparent.

Key points

  • Cannabis use has increased as a result of decriminalization and legalization, but the cardiovascular effects need research to inform public health policies.

  • Cannabis, via cannabinoid receptor 1 (CB1)-mediated oxidative stress and inflammation, is linked to adverse cardiovascular outcomes, including myocardial infarction, arrhythmias and cardiomyopathy.

  • CB1 antagonists and CB2 agonists are promising novel treatments for cardiovascular risk factors and cardiovascular disease, but clinical translation is complicated by adverse effects and limited data.

  • Synthetic cannabinoids (such as ‘K2’ and ‘Spice’) are an emerging public health concern owing to their potent toxicity and cardiovascular implications.

  • The co-use of cannabis and tobacco has synergistic adverse effects on cardiovascular health and addiction potential.

  • Induced pluripotent stem cell modelling and genetic tools should be used to discover novel cannabinoid signalling pathways and potential new therapeutic targets for cardiometabolic disease.

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Fig. 1: Mechanism of action of cannabinoids on cardiovascular health.
Fig. 2: The legal status of cannabis around the world.
Fig. 3: Cannabis modulates blood pressure via the nervous system, with immune, cardiac and renal inputs.
Fig. 4: Cannabinoid receptor 1 and heart failure.

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Acknowledgements

The authors are supported by the Heart and Stroke Barnett-Ivey Chair (to M.C.), the Tobacco-Related Disease Research Program (TRDRP, T34FT8070) and the American Heart Association (AHA, 23DIVSUP1076489) (to N.J.-T.), the Stanford Cardiovascular Institute, TRDRP (27IR-0012), Gootter-Jensen Foundation and the AHA (20YVNR3500014) (to J.C.W.).

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  1. Stanford Cardiovascular Institute, Stanford, CA, USA

    Mark Chandy, Nerea Jimenez-Tellez & Joseph C. Wu

  2. Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA

    Mark Chandy, Nerea Jimenez-Tellez & Joseph C. Wu

  3. Department of Medicine, Western University, London, Ontario, Canada

    Mark Chandy

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M.C. is a consultant for Greenstone Biosciences. J.C.W. is a co-founder and on the Scientific Advisory Board of Greenstone Biosciences. N.J.-T. declares no competing interests.

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Chandy, M., Jimenez-Tellez, N. & Wu, J.C. The relationship between cannabis and cardiovascular disease: clearing the haze. Nat Rev Cardiol 22, 467–481 (2025). https://doi.org/10.1038/s41569-025-01121-6

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