Abstract Body (Do not enter title and authors here): Background: Cannabis is among the most widely used psychotropic substances globally. With its increasing prevalence, questions have arisen regarding its potential impact on cardiovascular and cerebrovascular health. While multiple studies have explored the association between cannabis use and the risk of cardiovascular and cerebrovascular diseases, findings across these studies have been inconsistent, necessitating a comprehensive evaluation to elucidate the true nature of this relationship.

Aim: This meta-analysis aims to investigate the association between cannabis use and the risk of myocardial infarction (MI) and stroke.

Methods: A systematic search was conducted in relevant electronic databases, including PubMed, EMBASE, and SCOPUS, from inception to April 2024. Inclusion criteria comprised observational studies evaluating the association between cannabis use and events such as MI and stroke. Two reviewers independently screened studies, extracted data, and assessed quality. A random-effects meta-analysis was performed to estimate pooled ORs and 95% CIs. Heterogeneity was assessed using I² statistic.

Results: Our meta-analysis included data from 26 studies, with a total population of 72,551,926 individuals of whom 69.5% were female. Among these, 7,832,105 individuals (2.1%) were identified as cannabis users, with 41.2% being female. Cannabis users exhibited significantly higher odds of experiencing MI (OR= 1.38, 95%CI: 1.14-1.68) and stroke (OR= 1.43, 95%CI: 1.08-1.89) compared to non-users. When considering stroke subtypes, while the odds of ischemic stroke among cannabis users showed a trend toward elevation (OR= 1.60, 95%CI: 0.91-2.81), the difference was non-significant. Similarly, the odds of hemorrhagic stroke among cannabis users did not reach statistical significance when compared to non-users, (OR= 1.98, 95%CI: 0.80-4.88).

Conclusions: Our analysis reveals a significant increase in the odds of both MI and stroke in cannabis users. Notably, we observed a comparable yet increased trend in both ischemic and hemorrhagic stroke subtypes. Further research is crucial to delineate these associations and understand the underlying mechanisms.