Introduction:
Cardiovascular disease (CVD) is a leading global cause of morbidity and mortality. As cannabis legalization expands, its potential impact on cardiovascular health remains poorly understood, with conflicting evidence. This study investigates the associations between cannabis use, cardiovascular risk markers, and calculated risk scores, stratified by age and product types.

Methods:
We conducted retrospective cohort study on 3,207 patients (1,069 cannabis users and 2,138 non-users) using data from electronic health records linked to cannabis dispensaries Point of Sale data from 2016-2024, using MSA de-identification, HIPAA compliant engine. We assessed ASCVD 10-year risk scores in older adults (40-79 years), and lifetime cardiovascular risk in younger adults (20-39 years) using AHA defined algorithms. We used Propensity Score Matching to balance groups, and regression models to analyze outcomes, adjusting for key covariates.

Results:
Cannabis use was associated with significant changes in cardiovascular markers, including lower systolic blood pressure (β= -4.28 mmHg, p < 0.001), higher total cholesterol (β= 7.10 mg/dL, p < 0.001), higher HDL cholesterol (β = 6.91 mg/dL, p < 0.001), and lower LDL cholesterol (β= -7.59 mg/dL, p < 0.001). In older adults, cannabis use was not significantly associated with higher 10-year CV risk (β = -1.45, p = 0.382), with age, male gender, and diabetes being the primary risk predictors. Cannabis use was significantly associated with higher odds of high lifetime cardiovascular risk in younger adults (OR = 6.71, p < 0.001). Product type and THC:CBD ratios influenced outcomes, with vapes associated with higher cardiovascular risk, while edibles and tablets/capsules showed lower risks (p < 0.001). In older adults, products with High THC or High CBD content were associated with significantly higher 10-year CV risk compared to Balanced products (p < 0.001). THC percentage was positively associated with both 10-year (β = 0.064, p < 0.001) and lifetime risk (OR = 1.013, p < 0.001), and CBD percentage was inversely associated with 10-year risk (β = -0.033, p < 0.001).

Conclusion:
Cannabis use affects cardiovascular risk markers, with potential cardioprotective effects on cholesterol but variable impacts on risk scores depending on age, product type, and THC:CBD ratios. Tailored recommendations considering individual cardiovascular profiles and cannabis composition are essential. Further research is needed to explore these complex relationships.

Learning Objectives:

• Describe how cannabis use influences key cardiovascular risk markers

• Compare cardiovascular risk outcomes associated with different cannabis product types and THC:CBD compositions

• Evaluate the differential impact of cannabis use on CV risk in older adults and younger adults