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Dan_- 5 hours ago

Exactly. Being unable to account for this covariate (tobacco use) pretty much invalidates this analysis. The odds ratio for tobacco use is basically the same (3x).

Also, title needs a 2025.

mil22 5 hours ago | parent | next [-]

This article refers to two studies. The retrospective study of 4.6 million people did account for tobacco use.

> The findings are from a retrospective study of over 4.6 million people published in JACC Advances and a meta-analysis of 12 previously published studies being presented at the American College of Cardiology's Annual Scientific Session (ACC.25).

> Kamel and his team conducted the retrospective study using data from TriNetX, a global health research network that provides access to electronic medical records. Their findings indicate that over an average follow-up of over three years, cannabis users had more than a sixfold increased risk of heart attack, fourfold increased risk of ischemic stroke, twofold increased risk of heart failure and threefold increased risk of cardiovascular death, heart attack or stroke. All study participants were younger than age 50 and free of significant cardiovascular comorbidities at baseline, with blood pressure and low-density lipoprotein (LDL) cholesterol levels within a healthy range and no diabetes, tobacco use or prior coronary artery disease.

chuckadams 4 hours ago | parent [-]

I know you can't judge a study by its abstract, but they don't even mention the dosing mechanism, it's just "cannabis use".

mil22 4 hours ago | parent [-]

That's not really a fair standard by which to judge the study, abstract or not. The dosing mechanism information was not present in the underlying dataset available to them:

> This retrospective cohort study utilized the TriNetX health research network, which aggregates deidentified electronic medical records from health care organizations worldwide.

> 1) The cannabis-user group with cannabis use diagnoses (International Classification of Diseases, 10th Revision: F12.1, F12.9, F12.90).

You can't expect them to work miracles and come up with data they didn't have. They produced a valuable piece of research furthering our understanding of the cardiovascular risks of cannabis use based on a very large existing dataset that was available to them.

Of course they would love to be able to answer the question of whether smoking is worse for your heart than edibles and so on, and they stated they would like to do this in a future study. But that costs time and money to create an entirely new dataset, and you know what funding for science is like these days.

There's plenty of other evidence in the literature on the cardiovascular effects of THC if you want to see what our current understanding is there. TL;DR: smoking is worse than vaping or edibles; myocardial infarction risk spikes within the first few hours of using cannabis; but the risks are not limited to inhalation because THC itself has physiological effects that raise cardiovascular risk factors (increased heart rate, endothelial dysfunction, platelet activation raising clotting risk, inflammation and oxidative stress, etc.).

brookst 3 hours ago | parent [-]

Did they though? Not accounting for confounding factors like “other drugs” seems to indicate it’s not about the risks of cannabis use so much as the risks from all sources that the average cannabis user faces. Using only cannabis might have zero impact or even be beneficial based on this evidence (if you hypothesize that most of the negative outcomes were cannabis+cocaine users, for instance).

Still good data, but I don’t think it’s predictive for what cannabis use leads to (unless you assume that taking up cannabis makes you proportionately more likely to also take up whatever the confounding factors were).

Spooky23 an hour ago | parent | next [-]

With a metastudy based on EMR data, I’d only use this to advocate for studying the issue further.

Information like this get collected at a point in time and never goes away. People have EMR fatigue and click though the questions. Anecdotal point, several years ago I accidentally stated that I drank enough to be considered a severe alcoholic. Even after correcting it at my next visit, it never really goes away, I get asked lifestyle questions relating to alcoholism.

Similarly advocacy against drunk driving, a noble cause, juiced up the stats. If you run over and injure a guy on the sidewalk carrying a sealed bottle of liquor, it will be labeled “alcohol related” more often than not based on officer discretion. If it’s fatal, the autopsy will take that conclusion if any party has a 0.01 BAC.

mil22 3 hours ago | parent | prev [-]

They didn't find that cannabis use leads to cardiovascular disease. They found a strong association between cannabis use and cardiovascular disease in a very large study. Correlation isn't causation. The study itself acknowledges that. That doesn't mean it's an invalid or useless study that didn't add to the body of scientific knowledge and evidence about the relationship between cannabis use and cardiovascular disease - I think we agree there. That's how science works. Observational studies do not definitively prove causality.

After reading the study, should we update our posterior on the hypothesis that cannabis use causes cardiovascular disease to nudge it in the direction that it does? Yes - that's just Bayes' theorem. Does the probability go to 95%+? No, of course not; I'm not claiming otherwise. It's still useful research.

Also, worth noting that MI risk spikes several-fold within the first hour after cannabis use (and that's not caused by cocaine).

detourdog 4 hours ago | parent | prev [-]

Not to mention cocaine.

xprnio 3 hours ago | parent [-]

The cannabis to cocaine pipeline sadly is real, whether we want to or not. As long as the same people we buy our weed from also have a chance of being the people that have cocaine for you to buy, all that’s left to figure out is the money and the willingness to buy some.

(Sadly speaking from experience)

BunsanSpace an hour ago | parent | next [-]

No.

Cannabis is a multi purpose drug, cocaine is party drug and/or a "I haven't slept, don't want the 8 hour+ commitment of speed, but need to stay awake" drug.

The overlap of pot users and cocaine users is rather small in my anecdotal experience.

bushwart 3 hours ago | parent | prev | next [-]

Legal cannabis sends its greetings, if you're lucky enough to live in a country where you can acquire it without having make any shady acquaintances.

jgerrish 30 minutes ago | parent [-]

Especially if medical prescriptions for it aren't necessary.

Confounding migraines for weed prescriptions and very real stroke risk and a desire for low THC marijuana isn't going to be a happy show I want to go through watching that happen to friends.

It makes a mockery of real medical issues.

Doctors and health care should be involved in drug use and advising patients, maybe even clean supplies or other things.

But we got the ACA of public health options with medical marijuana. And I want to remember Obama and others for inspiring us, not hacks.

A lot of people won't be believed in time.

Thraway198 an hour ago | parent | prev | next [-]

I have smoked cannabis for 20 years and I have never known anyone fall into the "cannabis-to-cocaine pipeline."

Everyone I knew who developed coke problems had drinking problems first. Bar none.

calmworm 3 hours ago | parent | prev | next [-]

This is odd to me. The X to Y pipeline is real if A, B, and C also align. It’s a weak correlation that sounds a lot like the “gateway drug” propaganda.

goodroot 3 hours ago | parent | prev | next [-]

That's interesting and probably an argument for pro-legalization.

Were I to pick a gateway drug into cocaine, it would be alcohol. It becomes a way to infuse more energy in a later night, which is usually one of alcoholic revelry.

When cannabis is just in a store and it's the only thing there, many potheads just stay in the pothead bubble.

sscaryterry 3 hours ago | parent [-]

Exactly, alcohol IMHO affects judgment significantly worse than cannabis.

Thraway198 an hour ago | parent [-]

AND its a heavy party drug, which cannabis is notoriously not

nephihaha 3 hours ago | parent | prev [-]

I am aware of someone who does both, because I overheard someone discussing it with him. Cannabis will retain a black market when it becomes a government cash cow.

PaulHoule an hour ago | parent | next [-]

Back in college I had a friend find a new dealer who he thought was pretty cool until he tossed out a rock in the middle of a pot deal, my friend never went back.

Myself I have been involved with weed a long time and never seen cocaine though my son did go into town one night and lock himself out of his car and have an experience we call "the night of the living baseheads."

The best drug dealer at my old school was a guy who would take chances nobody else would; I knew him somebody who dealt weed, psychedelic mushrooms and acid to my friends although I was persona-non-gratis with him because he was seriously criminally minded and led a gay bashing gang that mostly bashed straight people who were perceived as allies [1], although it took just one snarky comment (my case) or advising somebody being shot at with a paint pellet gun to see the police (the popular president of the paint pellet gun club.)

He eventually got caught bashing in an RA in the face with a rock shot with one of those rubber band catapults people use to shoot water balloons at the beach. He was banned from campus but I saw him once when he was dropping off a delivery for a friend. My friend later told me that he'd been caught on videotape dealing 3kg of cocaine to an undercover cop and he did time.

That's an unusual case. Except for that guy and the Vietnamese kid who took money and never delivered the weed to my wife when she was in high school, all the pot dealers I knew were basically responsible and law-abiding people who only dealt pot and other soft drugs. Funny somebody dropped a dime on the later.

[1] this was the 1980s during peak AIDS panic and I guess they were afraid if they spilled gay blood they might get AIDS or something

Thraway198 an hour ago | parent | prev [-]

I live in a legalized Marijauna country and there is no black market. The prices in the legal stores are actually lower than the former black market prices.