Cumulative Marijuana Use and Carotid Intima-Media Thickness at Middle Age: The CARDIA Study

Am J Med. 2021 Jun;134(6):777-787.e9. doi: 10.1016/j.amjmed.2020.11.026. Epub 2020 Dec 24.


Background: Long-term cardiovascular health effects of marijuana are understudied. Future cardiovascular disease is often indicated by subclinical atherosclerosis for which carotid intima-media thickness is an established parameter.

Methods: Using the data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of 5115 Black and white women and men at Year 20 visit, we studied the association between carotid intima-media thickness in midlife and lifetime exposure to marijuana (1 marijuana year = 365 days of use) and tobacco smoking (1 pack-year = 20 cigarettes/day for 365 days). We measured carotid intima-media thickness by ultrasound and defined high carotid intima-media thickness at the threshold of the 75th percentile of all examined participants. We fit logistic regression models stratified by tobacco smoking exposure, adjusting for demographics, cardiovascular risk factors, and other drug exposures.

Results: Data was complete for 3257 participants; 2722 (84%) reported ever marijuana use; 374 (11%) were current users; 1539 (47%) reported ever tobacco smoking; 610 (19%) were current smokers. Multivariable adjusted models showed no association between cumulative marijuana exposure and high carotid intima-media thickness in never or ever tobacco smokers, odds ratio (OR) 0.87 (95% confidence interval [CI]: 0.63-1.21) at 1 marijuana-year among never smokers and OR 1.11 (95% CI: 0.85-1.45) among ever tobacco smokers. Cumulative exposure to tobacco was strongly associated with high carotid intima-media thickness, OR 1.88 (95%CI: 1.20-2.94) for 20 pack-years of exposure.

Conclusions: This study adds to the growing body of evidence that there might be no association between the average population level of marijuana use and subclinical atherosclerosis.

Keywords: Carotid intima-media thickness; Cumulative exposure; Marijuana; Subclinical atherosclerosis; Tobacco.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Alabama / epidemiology
  • California / epidemiology
  • Carotid Intima-Media Thickness / classification*
  • Chicago / epidemiology
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Marijuana Use / adverse effects*
  • Marijuana Use / epidemiology
  • Middle Aged
  • Minnesota / epidemiology
  • Odds Ratio
  • Risk Factors
  • Ultrasonography / methods
  • Weights and Measures / instrumentation