Cannabis Use and Heart Failure, A Modifiable Risk Worth Attention

Abstract

The study by Inam et al. published in this issue of the Pakistan Heart Journal gives valuable evidence linking cannabis use with heart failure, especially heart failure with reduced ejection fraction (HFrEF). Conducted at Hayatabad Medical Complex, Peshawar the cross sectional study of 380 patients found that HFrEF was more common in cannabis users (60%) than in non-users (50%) (p = 0.03) [1]. These findings are consistent with recent international studies showing that cannabis users have higher rates of arrhythmia, myocardial dysfunction, and hospital admission. Importantly, users in this Pakistani cohort were generally younger, suggesting that cannabis may contribute to early cardiovascular injury [2-9]. Cannabis can affect the heart through several mechanisms by sympathetic activation, oxidative stress, endothelial injury, and vascular inflammation. It can also worsen metabolic stress in patients with hypertension or diabetes. When combined these factors may accelerate left ventricular dysfunction and heart failure progression [2-9]. Clinicians should routinely ask patients with heart failure about cannabis use especially younger individuals with unexplained systolic dysfunction. Counselling to stop cannabis use should be integrated into cardiac rehabilitation and outpatient care programs [2-9]. From a public health perspective cannabis should be recognised as a modifiable cardiovascular risk factor, similar to smoking or alcohol. Public awareness efforts and heart failure registries can incorporate cannabis screening to guide education, prevention and early intervention [2-9]. Although this was a single centre study, it provides an important foundation for larger national and regional research to explore dose response relationships and the reversibility of cardiac injury after cessation. In summary Inam et al. remind clinicians and policymakers that cannabis is not harmless. It can harm the heart and should be regarded as a preventable cause of heart failure, particularly among younger people. AUTHORS' CONTRIBUTION AKN, BM, and MTM: Concept and design, data acquisition, interpretation, drafting, final approval, and agree to be accountable for all aspects of the work. Acknowledgment: None. Funding: No specific grant for this research from any public, commercial, or not-for-profit funding agency References Inam S, Saeed I, Khan QA, Aamir M, Din HNU, Khan O. Prevalence and Incidence of Heart Failure among Cannabis Users: A Cross-Sectional Study. Pak Heart J. 2025;58(04):414-420. DOI: 10.47144/phj.v58i4.2970 Chandy M, Jimenez-Tellez N, Wu JC. The relationship between cannabis and cardiovascular disease: clearing the haze. Nat Rev Cardiol. 2025; 22: 467-481. DOI: 10.1038/s41569-025-01121-6 Storck W, Elbaz M, Vindis C, Déguilhem A, Lapeyre-Mestre M, Jouanjus E. Cardiovascular risk associated with the use of cannabis and cannabinoids: a systematic review and meta-analysis. Heart. 2025;111(22):1047-1056. DOI: 10.1136/heartjnl-2024-325429 Kamel I, Mahmoud AK, Twayana AR, Younes AM, Horn B, Dietzius H. Myocardial infarction and cardiovascular risks associated with cannabis use. JACC Advances. 2025; DOI: 10.1016/j.jacadv.2025.101698. American College of Cardiology. Cannabis Users Face Substantially Higher Risk of Heart Attack. Press Release. March 17, 2025. Available at: https://www.acc.org British Medical Journal Group. Cannabis Use Linked to Doubling in Risk of Cardiovascular-Disease Death. BMJ News. June 2025. Dhillon BK, Sombans S, Verma R, et al. Cannabis use among young females admitted for heart failure in the United States. Circulation. 2023; 147(Suppl 1): AP580. Patel RS, Gonzalez MD, Ajibawo T, Baweja R. Cannabis use disorder and increased risk of arrhythmia-related hospitalization in young adults. Am J Addict. 2021; 30(6): 578-584. DOI: 10.1111/ajad.13215 Richards JR, Blohm E, Toles KA, Jarman AF, Ely DF, Elder JW. The association of cannabis use and cardiac dysrhythmias: a systematic review. Clin Toxicol (Phila). 2020 Sep;58(9):861-869. DOI: 10.1080/15563650.2020.1743847