Quote from Benjamin Caplan on March 21, 2025, 2:09 pm

Why ignoring the cardiovascular conversation around cannabis is risky business, (or at least this new review paper suggests that!)

 

Most people in the cannabis community that are thinking about cannabis and heart health are not thinking that cannabis may come with serious downsides.  The cannabis friendly generally find cannabis to be a welcome, relaxing, and healing part of their lives, and  because it works so much better than many other medicines or therapies, few look back and consider the real risks of cannabis on heart health. Ultimately, cannabis is a vegetable buffet. it's packed with some of nature's finest chemistry, and some of the things in nature can have thorns or toxins that will impact vulnerable individuals in potentially negative ways.  The details matter!

 

This post looks at the details from a  comprehensive 2025 review, “The relationship between cannabis and cardiovascular disease: clearing the haze” by Chandy, Jimenez-Tellez, and Wu, published in Nature Reviews Cardiology (doi:10.1038/s41569-025-01121-6). The paper examines how various cannabinoids—traditional, synthetic, and hemp-derived—interact with the cardiovascular system, highlighting both therapeutic potentials and well-substantiated risks such as arrhythmias, myocardial infarction, and vascular inflammation. It does an excellent job of organizing decades of scattered research into a readable, mechanistically rich overview, though it leans heavily on preclinical models and lacks practical guidance for clinicians navigating real-world patient care.

 

✅ TL;DR (Top 5 Takeaways)

 

 

1. Cannabis use is rising worldwide, but its cardiovascular risks remain underrecognized.

 

2. THC-heavy products can negatively impact heart health via CB1 receptor activation. (high doses, taken frequently)

 

3. CBD and other cannabinoids might offer protective cardiovascular effects—but research is young.

 

4. Synthetic cannabinoids (e.g., Spice, K2) pose serious, often life-threatening risks.

 

5. A nuanced, physician-guided approach to cannabis is essential for patient safety.

 

 

5 Alarming Truths About Cannabis and Heart Health

 

 

1. Cardiovascular Disease Isn’t Just a Tobacco Problem Anymore

 

The idea that only cigarettes hurt your heart is going the way of the rotary phone.

 

Cannabis, particularly THC-dominant strains, when taken in large amounts and often, can been shown to correlate to myocardial infarction (heart attack) risk, trigger arrhythmias, and in some cases, contribute to heart failure. For context, “large amounts” typically refers to daily or near-daily use of high-THC products—think multiple sessions per day or consistent intake of concentrates. Most occasional users are unlikely to face these same cardiovascular risks, especially if their doses are low and spaced out. The culprit? CB1 receptors—those nifty little locks in your heart and blood vessels that THC loves to pick.

 

THC happens to excite the heart muscle directly, but also when CB1 gets activated - and without other compound mixtures to tone down the presence of high dose THC, it can drive inflammation, oxidative stress, and even endothelial dysfunction (translation: blood vessels that stop relaxing properly and get more prone to damage and clogging) because nobody else - like CBD, CBG, CBC - is there to calm the THC monster down). These mechanisms aren’t just theoretical—they’ve been demonstrated in mouse models, and human cell studies, and even stem cell simulations  [read PDF of the full paper here].

 

🧠 CB1, CB2, and Why It Matters

 

CB1 (the “uh-oh” receptor): Found in the brain and heart—activated by THC, can be linked to negative cardiac effects - in large amounts, at when consumed frequently.

 

CB2 (the “chill” receptor): More immune-focused, potentially protective in heart conditions.

 

Spoiler alert: Most recreational weed lights up CB1 way more than CB2. Companies advertise "THC thc THC THC" but it's not always pure and good when it's.... pure and good!

 

2. Not All Cannabinoids Are Created Equal

 

Imagine hosting a dinner party and inviting both a firefighter and an arsonist. That’s kind of what your body does when it ingests full-spectrum cannabis without supervision.

 

🔍 Traditional vs. Synthetic Cannabinoids

 

CBD: The golden child. Appears to have anti-inflammatory, vasodilatory, and anti-oxidative effects. Might actually help protect against ischemic injury and arrhythmias.

 

THC: Psychoactive, pro-inflammatory, and dose-sensitive. The heart doesn’t love it.

 

Synthetic cannabinoids (e.g., Spice, K2): These aren’t just bad—they’re terrifying. Full CB1 agonists that have been linked to fatal cardiac arrhythmias, MI, and sudden death, particularly in young adults .

 

These are not the cannabinoids you’ll find in dispensary edibles or vape pens. They’re more often found in unregulated products sold online or at gas stations, and they’re thankfully not a risk for most informed, everyday cannabis consumers.

 

It’s one thing to use a substance that’s tricky to regulate. It’s another to use one that can straight-up crash the system.

 

3. A Legal Fog: Regulation ≠ Safety

 

Let’s be clear: legal ≠ safe.

 

Thanks to the 2018 Farm Bill, hemp-derived cannabinoids like delta-8 and delta-10 THC now float in regulatory limbo—sold online, in gas stations, and often in products with no lab testing or dosage consistency.

 

Even more troubling: some of these synthetics have higher CB1 binding affinity than THC, meaning they hit harder and last longer, often with unknown side effects. And yes, heart complications are absolutely on the list.

 

4. CBD May Be the Exception to the Rule—but Hold Your Horses

 

CBD is currently enjoying the wellness spotlight, and not without reason. It’s being studied for everything from cardiomyopathy to hypertension, and shows some promise in reducing blood pressure and inflammation.

 

But… (and it’s a big but)…

 

CBD can:

 

Interact with other medications (SSRIs, beta-blockers, antipsychotics).

 

Cause hepatotoxicity (liver injury) at high doses.

 

Be wildly under-regulated, leading to contaminated or mislabeled products.

 

So no, it’s not a magic bullet—but it may be a tool if used correctly, monitored, and guided by, say, a real live clinician who knows your chart and what s/he is talking about, for example at CED clinic!  For example, if you’re using cannabis to help with sleep or chronic pain, your clinician can help find the right cannabinoid profile, dose, and schedule that minimizes risk to your cardiovascular system.

 

5. The Real Risk? We’re Under-Talking This Topic

 

Here’s the part that keeps docs up at night: despite the mounting data, most people—including patients and many clinicians—don’t know cannabis can impact cardiovascular health at all.

 

Even medical cannabis discussions are often siloed into neurology, oncology, or pain management. But the heart? It’s been getting the silent treatment.

 

What’s missing is contextual nuance. Who’s using? What dose? What delivery method? What other medications or risks are in play?

 

And let’s not forget the poly-drug effect—especially the high prevalence of combining cannabis and tobacco, which appears to exponentially magnify cardiovascular risk.

 

 

💬 Quick FAQ: Cannabis + Heart Health

Q: I use cannabis once or twice a week—should I be worried?

Probably not. The cardiovascular concerns in this review mostly apply to frequent, high-dose users.

Q: What counts as “high dose” cannabis use?

Regular intake of potent THC products (think concentrates, vapes, or strong edibles), especially multiple times a day.

Q: Can I talk to my doctor about this without judgment?

You should—and if your doctor brushes you off or doesn’t know how to answer, it’s time to find someone who understands cannabis medicine.

 

For More Basic FAQs, click here

For a full Encyclopedia of Cannabis FAQs, click here
 

🫀 Conclusion: Don’t Be Left in the (Cannabis) Smoke

 

 

We don’t need reefer madness or moral panic. What we do need is responsible curiosity—and more conversations that combine the science, the nuance, and the reality of modern cannabis use.

 

For clinicians: Ask your patients how they’re using cannabis. The answers may surprise you—and save a heart down the line.

 

For patients: Don’t assume your dispensary budtender has a medical degree. Or much of any medical knowledge at all. While many budtenders have real passion and helpful product knowledge, they’re more like baristas than cardiologists—great at helping you choose the flavor, but not the right person to manage your health plan. Many may have years of personal experience and experiential knowledge from friends, family, industry time, but think of them like waiters or waitresses.. they are not chefs, and they are not nutritionists.  Even the plant-based can pack a punch.

 

For everyone else: The future of cannabis medicine is bright—but only if we bring some clarity to the haze... and focus on more than just THC. And for the record—no, cannabis isn’t a gateway drug. That argument is about as useful as blaming oatmeal for dessert addiction. (More on that here)

 

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🔗 Suggested Links and Resources

 

External:

 

American Heart Association: Scientific Statement on Cannabis Use

 

FDA on CBD and THC Regulation

 

Internal:

 

CED Clinic Guide: Cannabis and Heart Health

 

5 Insights about Cannabis and Heart Health

 

Cannabis and Metabolism. - A Guide to the Full Picture

 

Cannabis and Older Adults – What We’ve Learned

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Got questions about your cannabis use and heart health? Drop them in the comments—I read them all, and we’re here for the smart questions, not the scare tactics.