Abstract Body: Background: Despite numerous reports suggesting a link between cannabis use and the risk of atherosclerotic cardiovascular diseases (ASCVD), the nature of this relationship—whether causal or not—remains uncertain.

Objective: We aimed to consolidate data from observational studies to examine the association between cannabis use and ASCVD outcomes compared to non-users or controls.

Methods: RevMan 5.4 was used for statistical analyses employing a random effects model, and outcomes were presented as risk ratios (RR) with corresponding 95% confidence intervals (CI). The study protocol has been registered with PROSPERO (CRD42024530366).

Results: Our analysis integrated data from 17 studies, including 1,902,481 individuals aged 18 to 74, with a mean follow-up duration of 8.5 years. The pooled analysis revealed no statistically significant association between cannabis use and the risk of myocardial infarction compared to non-users, with an RR of 1.25 (95% CI: 0.91 to 1.71, p = 0.17). Similarly, the risk of stroke did not show a significant association with cannabis use (RR: 1.38, 95% CI: 0.88 to 2.16, p = 0.16). However, a statistically significant association was found between cannabis use and the composite outcome of any adverse cardiovascular events (RR: 1.48, 95% CI: 1.16 to 1.90, p = 0.002).

Conclusion: The statistical correlations between cannabis use and composite adverse cardiovascular outcomes underscore its potential as a risk factor for cardiovascular disease. With rising trends in medical cannabis use and cannabis use disorder across age demographics, heightened risk awareness, CVD screening, and informed decision-making regarding cannabis consumption are critical priorities in healthcare and public health initiatives.