Correlation Between Cannabis Use and the Prevalence of Cerebrovascular Disease (Cva); Analysis From the National Inpatient Sample (NIS) 2012-2014

Background: With increasing legalization of cannabis, there is a growing number of cannabis users in the US. Cannabidiol - a component of cannabis with no psychoactive or cognitive effect has been proven in animal models to have vasodilatory and anti-inflammatory effect on the blood vessels. However, in clinical literature, the association between cerebrovascular accident (CVA) and cannabis remains inconclusive. Objective: To examine if there is a difference in the prevalence of CVA among patients who use cannabis and non-users. Methods: We identified patients > 18 years (N=12,114,360) from the 2012 -2014 National Inpatient Sample database. Using the ICD-9 code, we categorized patients using cannabis (non-dependent and dependent users) and non-users. Our outcome of interest was prevalence of CVA in this population. Logistic regression analysis was performed to assess the association between cannabis use and CVA. Using multivariate regression model, we adjusted for known confounders of CVA; age, gender, race, insurance type, socioeconomic status, tobacco use, cocaine use, alcohol abuse, amphetamine use, hyperlipidemia, diabetes, hypertension, renal failure, prior history of CVA and family history of CVA. Results: From our study sample (12,114,360 hospitalized patients), 2.1% (253,752) had a diagnosis of CVA, 1.48% (179,576) were non-dependent cannabis users and 0.21% (25,968) dependent users. Among hospitalized patient, non-dependent cannabis use was associated with an 8% increased odds of CVA (AOR 1.08 [1.03-1.13]) compared to non-users. However, dependent cannabis use was associated with a 60% decreased odds of CVA (AOR 0.40 [0.31-0.49]) compared to non-users. Also, In-group comparison shows a 60% decreased odds of CVA among dependent cannabis users (AOR 0.36[0.29-0.46]) compared to non-dependent cannabis users. Conclusions: Non-dependent cannabis use was associated with a slightly increased odd of CVA while dependent cannabis use was independently protective against CVA. Our study used the largest repository of clinical information to explore this association, however we recommend more clinical study to explore this correlation in other to maximize the pharmacological benefit of cannabidiol in cannabis for the prevention of CVA.