#72 Notable Clinical Interest
Emerging findings or policy developments worth monitoring closely.
Clinicians should screen for cannabis use disorder in patients presenting with stroke, particularly younger patients where traditional cardiovascular risk factors may be absent, as the evidence now links cannabis use disorder to both any stroke and large artery stroke subtypes. Understanding this association enables more comprehensive risk stratification and may inform conversations about substance use cessation as a modifiable stroke prevention strategy. Patients with cannabis use disorder should be counseled about stroke risk alongside other substance-related health consequences to support informed decision-making about continued use.
A systematic review and meta-analysis found that cannabis use disorder is associated with increased risk of any stroke and specifically large artery strokes, though the evidence showed some heterogeneity across studies and potential small-study effects. This finding is particularly relevant for clinicians assessing cardiovascular risk in patients with cannabis use disorder, as stroke represents a serious vascular complication that may warrant preventive interventions or closer monitoring. The mechanistic link likely involves cannabis-induced thrombotic and vasospastic effects, though the clinical relationship remains incompletely understood and warrants further investigation. Physicians should incorporate cannabis use disorder status into their stroke risk assessment algorithms and consider discussing this cardiovascular risk with patients who use cannabis regularly or meet criteria for use disorder. For patients with established cannabis use disorder, especially those with additional stroke risk factors, clinicians should counsel on smoking cessation and consider standard stroke prevention strategies while remaining alert to potential cannabis-related mechanisms of vascular injury.
“What we’re seeing in the stroke literature is that cannabis use disorder, not occasional use, carries a measurable vascular risk that clinicians need to screen for actively in their patient histories, particularly in younger stroke patients where we might otherwise miss the connection.”
? The association between cannabis use disorder and increased stroke risk reported in this meta-analysis warrants clinical attention, particularly given the growing prevalence of cannabis use and potential normalization of its safety profile among patients. However, clinicians should note significant heterogeneity in the cannabis findings and evidence of small-study effects, which suggest the true magnitude of risk remains uncertain and may be inflated by publication bias. The causal mechanisms linking cannabis to stroke are not fully established—confounding factors such as concurrent tobacco use, cardiovascular comorbidities, and the effects of other substances are difficult to fully disentangle in observational studies. When taking a substance use history, providers should specifically inquire about cannabis use patterns and frequency in patients presenting with stroke or those with multiple vascular risk factors, and counsel patients with existing stroke risk factors or personal/family history of stroke about the potential cerebrovascular implications of cannabis use disorder.
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