Background: Cannabis is the most used illicit drug in the world. Global trends of decriminalization and legali- zation of cannabis lead to various forms of cannabis use and bring great concerns over adverse events, partic- ularly in the cardiovascular (CV) system. To date, the association between cannabis and adverse CV events is still controversial.

Purpose: We aim to conduct a systematic review and meta-analysis to assess the adverse CV events from cannabis use.

Patients and methods: A systematic search for publications describing the adverse CV events of cannabis use, including acute myocardial infarction (MI) and stroke, was performed via PubMed, Scopus, and Cochrane Library databases. Data on effect estimates in individual studies were extracted and combined via random-effects meta- analysis using the DerSimonian and Laird method, a generic inverse-variance strategy.

Results: Twenty studies with a total of 183,410,651 patients were included. The proportion of males was 23.7%. The median age and follow-up time were 42.4 years old (IQR: 37.4, 50.0) and 6.2 years (IQR: 1.7, 27.7), respectively. The prevalence of cannabis use was 1.9%. Cannabis use was not significantly associated with acute MI (pooled odds ratio (OR): 1.29; 95%CI: 0.80, 2.08), stroke (pooled OR 1.35; 95%CI: 0.74, 2.47), and adverse CV events (pooled OR: 1.47; 95%CI: 0.98, 2.20).

Conclusion: The risk of adverse CV events including acute MI and stroke does not exhibit a significant increase with cannabis exposure. However, caution should be exercised when interpreting the findings due to the het- erogeneity of the studies.