Stroke rates are rising in adults between the ages of 18 and 45, according to the American Heart Association, and young adults account for up to 15% of strokes in the United States each year.

According to a new study, younger people who had a stroke or a transient ischemic attack (TIA) and were later hospitalized for any reason were far more likely to have a second stroke if they had a cannabis use disorder.

Cannabis use disorder is defined as dependent use of cannabis Cannabis use disorder is characterized as the use of cannabis in a compulsive manner despite a psychological, bodily, or social impairment.

The researchers looked at data from the National Inpatient Sample, a huge, publicly accessible database that collects information on over 7 million hospital stays each year across the United States. The participants in this study were 161,390 adults aged 18 to 44 who were hospitalized for any reason between October 2015 and October 2017, and whose medical records indicated a previous stroke (clot-caused or bleeding stroke) or TIA.

Researchers identified patients in the sample who met the criteria for cannabis use disorder using hospital diagnosis codes, omitting those whose cannabis dependence was in remission. This separated the 4,690 patients who had been diagnosed with cannabis use disorder from the 156,700 individuals who had not. Both groups had a median age of 37 years.

Patients with a cannabis use disorder were found to be more likely to suffer from:

• More likely to be male (55.2% vs. 40.9%), Black adults (44.6% vs. 37.2%), or to smoke tobacco (73.9% vs. 39.6%).
• More likely to be diagnosed with chronic obstructive pulmonary disease (21.5% vs. 19.0%), depression (20.4% vs. 16.1%) or psychosis (11.2% vs. 7.5%).
• Significantly more likely to abuse alcohol (16.5% vs. 3.6%).
• Less likely to have high blood pressure (53.1% vs. 55.6%), diabetes (16.3% vs. 22.7%), high cholesterol (21.6% vs. 24.1%) or obesity (12.0% vs. 19.6%).

As a comparison to current hospitalizations, the study found that:

• Among adults with cannabis use disorder, 6.9% were hospitalized for a recurrent stroke, compared to only 5.4% hospitalized without the disorder.
• After adjusting for demographic factors and relevant pre-existing medical conditions (age at admission, sex, race, payer status, median household income, type of admission, hospital bed-size, region, location/teaching status and other medical conditions including traditional cardiovascular risk factors), patients with cannabis use disorder were 48% more likely to have been hospitalized for recurrent stroke than those without the disorder.
• Cannabis use disorder was most prominent among males, young Black or white adults and those who lived in low-income neighborhoods or in the northeast and southern regions of the U.S. 

“Young marijuana users who have a history of stroke or TIA remain at significantly higher risk of future stroke. Therefore, it is essential to increase awareness among younger adults of the adverse impact of chronic, habitual use of marijuana, especially if they have established cardiovascular disease risk factors or previous stroke episodes,” said the authors.

Impairment of blood vessel function, changes in blood supply, an increased tendency to blood clotting, impaired energy production in brain cells, and an imbalance between molecules that harm healthy tissue and antioxidant defenses that neutralize them are all possible mechanisms that have emerged from other research on cannabis use disorder.

The findings of this study may not apply to older persons (those over 44 years old), who are more likely to have many chronic health issues and cardiovascular risk factors. The study’s limitations also include the fact that all data was obtained at a single moment in time rather than tracking people over time. Furthermore, while the hospital coding detected cannabis use disorder, the data did not include details on the amount and duration of cannabis use, or the treatments administered.

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