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People who use cannabis or its synthetic cousin, cannabinoids, are twice as likely to die from heart problems as those who abstain from the drugs, new research has found.

Recreational cannabis use remains illegal in most of Europe, but it is the region’s most commonly used drug. An estimated 8.4 per cent of adults – 24 million people – used cannabis in the past year, according to the European Union Drugs Agency (EUDA).

Cannabis is generally stronger and more diverse than in past decades, with users having a choice between smoking marijuana, edibles, cannabis concentrates, and cannabinoids, which are synthetic psychoactive drugs with a high concentration of  

Tetrahydrocannabinol (THC), the active ingredient in cannabis that makes people feel high.

That has prompted concern about the potential health consequences of modern cannabis – and the new study, published in the journal Heart, is the latest to show they carry weight.

In addition to the doubled mortality risks, cannabis use is tied to a 20 per cent higher risk of stroke and a 29 per cent higher risk of heart attacks or other types of acute coronary syndrome, which is when blood flow to the heart is severely restricted, the study found.

The findings raise “serious questions about the assumption that cannabis imposes little cardiovascular risk,” Stanton Glantz and Dr Lynn Silver, researchers at the University of California at San Francisco who were not involved with the study, said in a written comment.

For the analysis, a French research team assessed real-world data from 24 studies conducted between 2016 and 2023.

Most participants were between the ages of 19 and 59, and cannabis users were more likely to be younger and male compared with people who did not use the drug.

Notably, most of the studies were observational, meaning researchers can’t say that cannabis use causes heart problems directly. There was also a high risk of bias in most of the studies.

More research is needed to understand exactly how cannabis is linked to heart problems, and whether the risks differ based on the type of cannabis someone uses.

Despite the limitations, the study authors said their analysis is among the most comprehensive yet to probe the possible link between cannabis and heart problems in the real world.

Glantz and Silver pushed for health warnings on cannabis products and protections against secondhand smoke exposure, particularly as countries relax their cannabis laws and the drug becomes more easily available.

“Cannabis needs to be incorporated into the framework for prevention of clinical cardiovascular disease,” they said.