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In a recently published study JAMA network openedResearchers investigated whether cannabis use is associated with mortality from all causes, cancer and cardiovascular disease (CVD).

Their results show that heavy cannabis use is associated with a significantly higher risk of cardiovascular disease in women. However, they found no association between cancer and all-cause mortality in the entire sample of men and women.

Study: High lifetime cannabis use and mortality by gender. Image credit: Rawpixel.com/Shutterstock.comStudy: High lifetime cannabis use and mortality by genderImage credit: Rawpixel.com/Shutterstock.com

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Cannabis is the most widely used illicit drug in the world and its increasing legalization highlights the need to understand its effects on health.

Previous research has suggested possible cardiovascular risks associated with cannabis use. However, these studies have often focused on specific populations, limiting the generalizability of their findings.

In addition, there is a lack of research examining the different effects of cannabis on men and women. Although cannabis use for medicinal purposes is increasing, its safety and effectiveness for various medical conditions remain unclear.

Some studies have suggested an association between heavy cannabis use and increased all-cause mortality as well as increased cardiovascular mortality. However, other studies have failed to find such associations, often due to methodological limitations such as small sample sizes, short follow-up periods, or limited age ranges of participants.

To date, only one study has examined the association between cannabis use and cancer mortality, but no significant association was found.

About the study

This study addressed existing gaps by examining the gender-specific associations between lifetime cannabis use and cardiovascular disease, cancer, and all-cause mortality in a large sample of the general population.

The cohort study used data from the UK Biobank, a large-scale biomedical database of 502,478 people aged 40 to 69 years who were recruited between 2006 and 2010 in 22 cities across the UK.

Participants provided detailed health information through questionnaires, interviews, physical examinations and biological samples, and their data were linked to death dates up to December 19, 2020.

Cannabis use was self-reported and categorized as “never,” “light,” “moderate,” and “heavy” use based on lifetime frequency.

The study examined the association between cannabis use and mortality using Cox proportional hazard regression models, taking into account clinical and demographic variables.

Analyses were stratified by sex to account for potential differences between men and women. Mortality outcomes were defined using International Statistical Classification of Diseases and Related Health Problems (10th Revision) codes, and various covariates such as age, education, income, smoking habits, alcohol consumption, hypertension, diabetes, dyslipidemia, body mass index (BMI), previous cardiovascular disease, and antidepressant use were included in the models.

The study used Kaplan-Meier survival analyses, with two-sided P values ​​of less than 0.05 considered significant.

Results

For the study, 121,895 participants from the British Biobank were analyzed, with an average age of 55.15 years for women and 56.46 years for men.

Among the participants, 3.88% of men and 1.94% of women were heavy cannabis users. Over an average follow-up period of 11.8 years, there were 2,375 deaths, including 440 from cancer and 1,411 from cardiovascular disease.

Heavy cannabis use among men was associated with an increased risk of overall mortality (hazard ratio (HR)) of 1.28. However, after adjusting for all factors, use was not significantly associated with mortality from cardiovascular disease or cancer.

Among women, heavy cannabis use was associated with a higher risk of death from cardiovascular disease (HR 2.67) and a nonsignificant increase in all-cause and cancer mortality after full adjustment.

Particularly among female tobacco users, heavy cannabis use significantly increased the risk of all-cause mortality (HR 2.25), mortality from cardiovascular disease (HR 2.56), and mortality from cancer (HR 3.52).

In contrast, male tobacco users only had an increased risk of cancer mortality (HR 2.44). When participants with comorbidities were excluded, no significant associations were found between heavy cannabis use and mortality.

The results suggest that heavy cannabis use has gender-specific effects on mortality, particularly among women.

Conclusions

This study deviates from previous research that focused primarily on all-cause mortality among younger populations and shows that there is an increased risk associated with cannabis use.

Few studies have examined the association between cannabis use and cardiovascular disease mortality, and the results have been mixed. Some studies have suggested a significant association, others have not.

Strengths of the study include a large sample size and standardised data collection protocols from the UK Biobank. However, the cross-sectional design limits causal inferences and the low response rate could introduce participant bias.

The study’s focus on middle-aged participants from the UK limits the generalisability of the results to other demographic groups.

Self-reported data on cannabis use and the lack of current consumption patterns, dosing information, and tracking of cannabis use during the study period represent significant limitations.

Future research should include longitudinal studies to examine the potential causal effects of cannabis use on mortality, with a focus on accurately measuring cannabis use, including frequency, dosage, and methods of consumption.

Given the current inconclusive evidence, these studies should also aim to understand the gender effects and associations between cannabis use and cancer mortality.

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