Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke: A Population-Based Cohort Study of 45 000 Swedish Men

Stroke. 2017 Feb;48(2):265-270. doi: 10.1161/STROKEAHA.116.015565. Epub 2016 Dec 27.


Background and purpose: Current knowledge on cannabis use in relation to stroke is based almost exclusively on clinical reports. By using a population-based cohort, we aimed to find out whether there was an association between cannabis use and early-onset stroke, when accounting for the use of tobacco and alcohol.

Methods: The cohort comprises 49 321 Swedish men, born between 1949 and 1951, who were conscripted into compulsory military service between the ages of 18 and 20. All men answered 2 detailed questionnaires at conscription and were subject to examinations of physical aptitude, psychological functioning, and medical status. Information on stroke events up to ≈60 years of age was obtained from national databases; this includes strokes experienced before 45 years of age.

Results: No associations between cannabis use in young adulthood and strokes experienced ≤45 years of age or beyond were found in multivariable models: cannabis use >50 times, hazard ratios=0.93 (95% confidence interval [CI], 0.34-2.57) and 0.95 (95% CI, 0.59-1.53). Although an almost doubled risk of ischemic stroke was observed in those with cannabis use >50 times, this risk was attenuated when adjusted for tobacco usage: hazards ratio=1.47 (95% CI, 0.83-2.56). Smoking ≥20 cigarettes per day was clearly associated both with strokes before 45 years of age, hazards ratio=5.04 (95% CI, 2.80-9.06), and with strokes throughout the follow-up, hazards ratio=2.15 (95% CI, 1.61-2.88).

Conclusions: We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age. Tobacco smoking, however, showed a clear, dose-response shaped association with stroke.

Keywords: adolescent; cannabis; diet; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alcohol Drinking / adverse effects
  • Alcohol Drinking / epidemiology*
  • Cannabis / adverse effects
  • Cohort Studies
  • Follow-Up Studies
  • Health Surveys / methods
  • Humans
  • Male
  • Marijuana Smoking / adverse effects
  • Marijuana Smoking / epidemiology*
  • Middle Aged
  • Nicotiana / adverse effects
  • Population Surveillance* / methods
  • Risk Factors
  • Smoking / adverse effects
  • Smoking / epidemiology*
  • Stroke / diagnosis
  • Stroke / epidemiology*
  • Sweden / epidemiology