Regular use of cannabis, both marijuana smoking and tetrahydrocannabinol (THC)-edibles consumption, is associated with vascular endothelial dysfunction in otherwise healthy young adult users, according to the CANDIDE study published May 28 in JAMA Cardiology.

Leila Mohammadi, MD, PhD, et al., conducted a cross-sectional study of 55 adults (mean age 31 years, 37% women) living in San Francisco who did not smoke tobacco or vape or were frequently exposed to secondhand smoke. Participants, recruited from October 2021 to August 2024, were placed into three cohorts: marijuana smokers or THC-edible users (three or more smoking sessions or three or more edibles per week for one or more year) or nonusers. Flow-mediated dilation (FMD) and carotid-femoral pulse wave velocity (PWV) were measured to evaluate vascular endothelial function and vascular wall stiffness, respectively.

Results showed that arterial FMD was significantly lower in both marijuana smokers and THC-edible users compared with nonusers (mean 6.0% vs. 4.6% vs. 10.4%, respectively). However, no significant differences were observed in PWV or pulse wave analysis.

Findings also demonstrated inverse correlations between FMD and the amount of cannabis use (weekly number of smoking sessions and amount of edible THC consumed), indicating worsening of endothelial function.

Notably, vascular endothelial growth factor (VEGF)-stimulated nitric oxide levels in endothelial cells treated with participants' sera were significantly lower in marijuana smokers (mean 1.1 nmol/L) than nonusers (1.5 nmol/L) but not in THC-edible users (mean 1.5 nmol/L).

Mohammadi and colleagues write that chronic cannabis use is "associated with endothelial dysfunction similar to that in tobacco smokers, although apparently occurring via distinct mechanisms." They add that "this study enhances the understanding of the potential risks to vascular health linked to cannabis use and provides more evidence that cannabis use is not benign."