Prevalence and Incidence of Heart Failure among Cannabis Users: A Cross-Sectional Study

Abstract

Objective: To determine the prevalence and incidence of heart failure (HF) among cannabis users and explore potential pathophysiological mechanisms—such as sympathetic activation, oxidative stress, and vascular inflammation—through which cannabis may contribute to HF progression. Methodology: This retrospective cross-sectional study was conducted between July 2023 and December 2024 at the Hayatabad Medical Complex, Peshawar. A total of 380 patients were included, comprising 190 cannabis users and 190 non-users. Patients were evaluated for heart failure type, comorbidities, and cannabis use frequency. Heart failure was diagnosed using standardized echocardiographic criteria in conjunction with clinical judgment. Chi-square tests were used to assess associations, with statistical significance set at p<0.05. Results: Among the 380 patients, 55% were diagnosed with HFrEF, and 45% with HFpEF. The prevalence of HFrEF was significantly higher among cannabis users (60%) compared to non-users (50%) (p=0.03). Cannabis users were younger on average (44.3 years) than non-users (48.1 years), suggesting earlier cardiovascular involvement. Hypertension (35%) and diabetes (25%) were the most prevalent comorbidities. Notably, the combined prevalence of hypertension and diabetes was higher among cannabis users (18%) compared to non-users (12%). Conclusion: Cannabis use is significantly associated with HFrEF and appears to contribute to heart failure progression, particularly when comorbidities such as hypertension and diabetes are present. These findings underscore the need for public health strategies to address cannabis use as a modifiable cardiovascular risk factor, especially among younger populations.