. Author manuscript; available in PMC: 2018 Sep 26.

Published in final edited form as: Ann Intern Med. 2018 Jan 23;168(3):187–194. doi: 10.7326/M17-1548

Appendix Table 1.

Studies That Examined Exposure to MJ and CVD

Study, Year (Reference) Design	Study Population	Sample Size, n	Age, y	Cannabis Form/Route of Exposure	MJ Exposure Assessment^*	Outcome Examined	Follow-up	Findings^†	Risk of Bias	Funding Source
Danielsson et al, 2016 (27) Prospective cohort	Stockholm Public Health Cohort	17 833	18–84	Plant/smoke	Users categorized as never-/ever-users; 14.3% were ever-users	Diabetes (plasma glucose)	8 y	No association between MJ use and diabetes (OR, 0.94 [95% CI, 0.63–1.42])	High	Research Council for Health
Rajavashisth et al, 2012 (22) Cross-sectional	Participants from NHANES III (1988–1994)		20–59	Plant/smoke or edible	Participants categorized as light current users (≤4 d/mo) or heavy current users (≥5 d/mo); 36.7% and 8.8% reported past a nd current MJ use, respectively	1. Diabetes (plasma glucose, HbA_1c) 2. Dyslipidemia (HDL-C, LDL-C, TC, TG) 3. HTN	NA	Past users, current light and current heavy MJ users had lower prevalence of diabetes than non-MJ users (P < 0.001) All MJ users had higher prevalence of HDL-C >40 mg/dL, TC <240 mg/dL, and TG <200 mg/dL (P <0.0001), and current MJ users had higher prevalence of LDL-C <160 mg/dL (P < 0.05) No significant association between MJ use and HTN	Low	Multiple grants CDU, NIH
Bancks et al, 2015 (28) Prospective cohort	Adults without diabetes from CARDIA study	3151 at year 7, 3034 at year 25	18–30	NS/NS	Users were asked about number of days of use in prior 30 d and lifetime use (i.e., 1–2, 3–9, 10–99, or ≥100 times)	1. Diabetes (HbA-_1c, serum glucose) 2. Glucose intolerance (OGTT)	18 y	No association between MJ use and diabetes Current MJ users (OR, 1.65 [CI, 1.15–2.38])and lifetime users (OR, 1.49 [CI, 1.06–2.11]) had higher odds of impaired fasting glucose than nonusers Current MJ users (≥100 times) had elevated risk for prediabetes (HR, 1.39 [CI, 1.13–1.71]) than nonusers	Moderate	NIH, NHLBI
Permutt et al,1976 (29) Experimental study	Long-term MJ users	10	23–31	Plant/smoke	Participants who smoked MJ or placebo cigarette underwent a 5-h GTT	Plasma glucose levels	5-h OGTT assessed	No significant difference between peak BG, time of peak BG, low BG, total insulin secreted, peak insulin secreted, and time of peak insulin secretion	High	NIH, NlDA, NlAAA
Vidot et al, 2014(25) Cross-sectional	Adults without diabetes selected from NHANES (2005–2010)	8478	20–59	NS/NS	Users categorized as past and current MJ users (≥1 d in the past 30 d)	1. FBG 2. Dyslipidemia (HDLC, TG) 3. Metabolic syndrome	NA	Past and current MJ users had lower mean FBG than never-users (P = 0.03) Among men, past and current MJ users had higher mean HDL-C than never-users (P < 0.001) Among male current MJ users, prevalence of elevated waist circumference was significantly lower than that of never-users (P< 0.0001) Past (OR, 0.61 [CI, 0.40–0.91]) and current (OR, 0.49 [CI, 0.25–0.97]) MJ users less likely than never-users to have metabolic syndrome	High	NIH/NIDA, NIH/NIMHD
Thompson and Hay, 2015(23) Cross-sectional	Participants from NHANES (2005–2012)	6281	20–59	NS/NS	Users categorized as past and current MJ users (≥1 d in the past 30 d)	1. FBG 2. Dyslipidemia (HDLC, TG) 3. Obesity (BMI)	NA	Although simple regression analyses demonstrated current MJ use was associated with lower BMI, instrumental variable analysis demonstrated no significant relationship between current MJ use and any metabolic parameters, including FBG, TG, HDL-C, and BMI	Low	None
Ngueta et al, 2015 (31) Cross-sectional	Adults without diabetes	786	18–74	NS/NS	Participants grouped as users if they reported use in past 12 mo and as nonusers if they reported no use during same period	1. FBG 2. Dyslipidemia (HDL-C, LDL-C, TG, TC) 3. Obesity (BMI)	NA	No association between MJ use and FBG (P = 0.76), TC (P = 0.29), LDL-C (P = 0.08), HDL-C (P = 0.50), orTG (P = 0.1 3) MJ use was associated with lower prevalence of obesity (OR, 0.56 [CI, 0.37–0.84]) after adjustment for other factors	Moderate	Nunavik Regional Board of Health and Social Services
Reichenbach et al, 2015 (30) Randomized controlled trial	Patients with normal results on stress testing	19	18–75	Synthetic/oral	NA	1. FBG 2. Dyslipidemia (HDL-C, LDL-C, TG, TC) 3. Obesity (BMI)	4 wk	Dronabinol exposure had no significant change in BG (P = 0.84), TC (P = 0.84), HDL-C (P = 0.28), TG (P = 0.44), or BMI (P = 0.63) before and after treatment compared with placebo group	High	American College of Gastroenterology
Muniyappa et al, 2013 (24) Cross-sectional	Case patients are healthy MJ users	30 case patients, 30 control participants	21–28	Plant/smoke	Case patients were adults who smoked (self-reported) 4 d/wk for at least 6 mo	1. FBG 2. Dyslipidemia (HDL-C, LDL-C, TG, TC)	NA	MJ smokers (median 6 joints/day) had no significant difference in FBG, insulin, TC, LDL-C, orTG compared with control participants MJ users had lower plasma HDL-C levels (40 ± 14 mg/dL) than control participants (55 ± 13 mg/dL) (P = 0.02)	High	NIDDK, NIH, NIDA
Penner et al, 2013 (21) Cross-sectional	Adults without diabetes (NHANES, 2005–2010)	4657	20–59	NS/smoke	Participants grouped as past users, current users (≥1 d in the past 30 d), and never-users	1. FBG 2. HbA_1c 3. Dyslipidemia (HDL-C, TG) 4. BMI	NA	Current MJ users had a higher HDL-C level (1.63 mg/dL [CI, 0.23–3.04]) than never-users No association with FBG, HbA-_1c, TG, or BMI	Low	None
Hayatbakhsh et al, 2010(33) Retrospective cohort	Young adults from the MUSP cohort	2566	18.2–23.1 (mean, 20.4)	NS/NS	Exposure assessed once (at age 21 y) Usage graded as never, not in the past month, once or so, every few days, and every day	Obesity (BMI)	7 y	Regular MJ users were less likely to have BMI ≥25 (OR, 0.5 [CI, 0.3–0.8]; P < 0.01), and daily users were the least likely to have BMI ≥25 (OR, 0.2 [CI, 0.1–0.4]; P< 0.001)	High	National Health and Medical Research Council (Australia)
Rodondi et al, 2006 (26) Prospective cohort	Young adults from CARDIA study	3617	18–30	NS/smoke	Exposure assessed several times Users asked about number of days of use and lifetime exposure	1. Glucose 2. Dyslipidemia (HDL-C, TG) 3. Obesity BMI	Follow-up of 15 y	MJ use (average 10 d/mo) had no association with BG, TG, TC, HDL-C, or BMI	Low	NIH, Swiss National Foundation
Warren et al, 2005 (32) Cross-sectional	Female participants referred for weight management	297	16–79 (mean, 40.6 ± 1.64)	NS/NS	No information provided on exposure assessment	Obesity (BMI)	NA	Participants who used MJ in the past year had lower BMI (R² = 0.96; P = 0.0173), no adjustment for confounders	High	None

BG = blood glucose; BMI = body mass index; CARDIA = Coronary Artery Risk Development in Young Adults; CDU = Charles R. Drew University; FBG = fasting blood glucose; GTT = glucose tolerance test; HbA_1c = hemoglobin A_1c; HDL-C = high-density lipoprotein cholesterol; HR = hazard ratio; HTN = hypertension; LDL-C = low-density lipoprotein cholesterol; MJ = marijuana; MUSP = Mater-University of Queensland Study of Pregnancy; NA = not applicable; NHANES = National Health and Nutrition Examination Survey; NHLBI = National Heart, Lung, and Blood Institute; NIAAA = National Institute on Alcohol Abuse and Alcoholism; NIDA = National Institute on Drug Abuse; NIDDK = National Institute on Diabetes and Digestive and Kidney Diseases; NIH = National Institutes of Health; NIMHD = National Institute on Minority Health and Health Disparities; NS = not specified; OGTT = oral glucose tolerance test; OR = odds ratio; TC = total cholesterol; TG = triglycerides.

Cumulative lifetime exposure listed if presented in study.

^†

Reported findings are adjusted for baseline factors unless otherwise indicated.