Sex-Based Cardiovascular Risks Linked to Cannabinoid Use: Rakendu Rajendran, MBBS

Passionate about cardiovascular outcomes research, Rakendu Rajendran, MBBS, a third-year internal medicine resident with Virtua Health, presented 2 posters at the ASPC 2025 Congress on CVD Prevention. In part 1 of her interview with The American Journal of Managed Care®, she discusses findings from “Sex-Based Differences in Cardiovascular Outcomes Among Cannabinoid Users: A Retrospective Cohort Study Using TriNetX.”

“The significant findings we noticed from our study [were] that there was an increased incidence of MI [myocardial infarction] in males,” she notes, “and there was an increased incidence of stroke and females and increased incidence of major adverse cardiovascular events in males.”

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

Why is it important to study how cannabinoid use affects cardiovascular outcomes, and what is known about how these compounds affect the cardiovascular system?

I think the common understanding is that people think it's not without cardiovascular adverse effects as compared to tobacco use. People think it's benign, that it's a benign alternative, but anecdotally, a lot of senior physicians I work with feel that it is probably not, especially one of the interventional cardiology attendings that I've been working with, especially on research. He has noted that, anecdotally, he has been noticing a lot of MIs [myocardial infarctions] in these patient groups. That inspired us to look into these data, and when we did our literature review, there was very limited data on gender-specific outcomes in this patient valuation. That was something that motivated us to look into these data and do this study.

We did the study using the TriNetX database, and it was retrospective, and we used ICD [International Classification of Disease] coding, which is a limitation, so we were not able to assess the intensity of use but rather whether they used it or not. The follow-up duration was also 1 year, so it would be worthwhile to look into long-term outcomes of this. It's definitely something that's worth looking into, I think.

What prompted your study, and are there key findings you would like to highlight?

A lot of the senior physicians I've been working with have anecdotally noticed an increased incidence of MIs and other major adverse cardiovascular events in this patient population. The significant findings we noticed from our study [were] that there was an increased incidence of MI in males, there was an increased incidence of stroke in females, and there was an increased incidence of major adverse cardiovascular events in males.

Looking at the existing literature, interestingly, the preexisting literature points to an increased incidence of cardiovascular risk in females compared to males. Our study kind of contradicts what exists out there, and it's worthwhile looking into long-term outcomes, especially since the use is growing. Just based on observation among the general patient population, people are using marijuana more and more.

Can you speculate as to why incidence of MI was higher in males but stroke was higher in females?

I don't have a definitive answer to that. It is possible that, based on previous studies, at baseline, females tend to have a higher incidence of mental health disorders, excluding psychotic disorders. The patients who have a higher incidence of mental health disorders, excluding psychotic disorders and depression, have a predisposition to using more marijuana, based on the existing data.

We could speculate that these patients might exercise and may engage in other activities or may be having a lifestyle that is predisposing them to higher cardiovascular risk. That is possible, but I think to begin with, we need more prospective and long-term data to definitely understand more about this. But this is definitely a starting point, and we were, in fact, planning on doing a more robust study on this. It's in the pipeline.