Cannabis use in different ethnicity/race populations and risk of ischemic stroke: A systematic review and meta-analysis

Abstract

The global incidence of ischemic stroke among young adults has risen, with emerging evidence suggesting a potential link to increased cannabis use. Despite widespread perceptions of cannabis as a relatively safe substance, its association with ischemic stroke remains unclear, especially as legalization and use rates grow. This systematic review and meta-analysis aimed to synthesize the current literature to assess the relationship between cannabis use and the risk of ischemic stroke. Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Web of Science, Scopus, Embase, and Google Scholar (up to March 2025) to identify studies evaluating the association between cannabis use and ischemic stroke risk. Inclusion criteria required studies to compare cannabis users with non-users and report quantitative risk estimates (odds ratios, hazard ratios, or relative risks with 95% confidence intervals). Quality assessment utilized the Joanna Briggs Institute checklist. Data were pooled using a random-effects model, and heterogeneity was assessed with the I² statistic. From 821 initial records, seven studies (published 2007-2023; case-control, cohort, and cross-sectional designs) met inclusion criteria. The meta-analysis revealed a statistically significant association between cannabis use and increased risk of ischemic stroke (pooled OR = 2.05, 95% CI: 1.46-2.87; p < .001, I²=68.9%, p = .007). Cannabis use is associated with a significantly elevated risk of ischemic stroke, particularly among young adults. These findings highlight the need for further research to clarify causality and inform public health policy as cannabis use continues to rise globally.

Keywords: Cannabis; ischemic stroke; meta-analysis; systematic review.