Recreational marijuana use and acute ischemic stroke: A population-based analysis of hospitalized patients in the United States

Published:January 30, 2016DOI:


      • Marijuana use is most common in young, male, African American and Medicaid patients.
      • The incidence of AIS is higher in marijuana users compared to non-marijuana users.
      • Risk of marijuana-associated AIS increases with concurrent use of tobacco ± cocaine.
      • Marijuana use increases the likelihood of AIS, adjusting for stroke risk factors.
      • Marijuana use predicts symptomatic cerebral vasospasm, a proposed mechanism of AIS.



      Recreational marijuana use is considered to have few adverse effects. However, recent evidence has suggested that it precipitates cardiovascular and cerebrovascular events. Here, we investigated the relationship between marijuana use and hospitalization for acute ischemic stroke (AIS) using data from the largest inpatient database in the United States.


      The Nationwide Inpatient Sample was queried from 2004 to 2011 for all patients (age 15–54) with a primary diagnosis of AIS. The incidence of AIS hospitalization in marijuana users and non-marijuana users was determined. We utilized multivariable logistic regression analyses to study the independent association between marijuana use and AIS.


      Overall, the incidence of AIS was significantly greater among marijuana users compared to non-users (Relative Risk [RR]: 1.13, 95% CI: 1.11–1.15, P < 0.0001) and had the greatest difference in the 25–34 age group (RR: 2.26, 95% CI: 2.13–2.38, P < 0.0001). Marijuana use was more prevalent among younger patients, males, African Americans, and Medicaid enrollees (P < 0.0001). Marijuana users were more likely to use other illicit substances but had less overall medical comorbidity. In multivariable analysis, adjusted for potential confounders, marijuana (Odds Ratio [OR]: 1.17, 95% CI: 1.15–1.20), tobacco (OR: 1.76, 95% CI: 1.74–1.77), cocaine (OR: 1.32, 95% CI: 1.30–1.34), and amphetamine (OR: 2.21, 95% CI: 2.12–2.30) usage were found to increase the likelihood of AIS (all P < 0.0001).


      Among younger adults, recreational marijuana use is independently associated with 17% increased likelihood of AIS hospitalization.


      NIS (Nationwide Inpatient Sample), AHRQ (Agency for Healthcare Research and Quality), HCUP (Healthcare Cost and Utilization Project), ICD-9-CM (International Classification of Diseases, Ninth Edition, Clinical Modification), CCS (Clinical Classification Software)


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