Cannabis, Tobacco, Alcohol Use, and the Risk of Early Stroke

Abstract

Background and Purpose-Current knowledge on cannabis use in relation to stroke is based almost exclusively on clinical reports. By using a population-based cohort, we aimed to find out whether there was an association between cannabis use and early-onset stroke, when accounting for the use of tobacco and alcohol. Methods-The cohort comprises 49 321 Swedish men, born between 1949 and 1951, who were conscripted into compulsory military service between the ages of 18 and 20. All men answered 2 detailed questionnaires at conscription and were subject to examinations of physical aptitude, psychological functioning, and medical status. Information on stroke events up to ≈60 years of age was obtained from national databases; this includes strokes experienced before 45 years of age. Results-No associations between cannabis use in young adulthood and strokes experienced ≤45 years of age or beyond were found in multivariable models: cannabis use >50 times, hazard ratios=0.93 (95% confidence interval [CI], 0.34-2.57) and 0.95 (95% CI, 0.59-1.53). Although an almost doubled risk of ischemic stroke was observed in those with cannabis use >50 times, this risk was attenuated when adjusted for tobacco usage: hazards ratio=1.47 (95% CI, 0.83-2.56). Smoking ≥20 cigarettes per day was clearly associated both with strokes before 45 years of age, hazards ratio=5.04 (95% CI, 2.80-9.06), and with strokes throughout the follow-up, hazards ratio=2.15 (95% CI, 1.61-2.88). Conclusions-We found no evident association between cannabis use in young adulthood and stroke, including strokes before 45 years of age. Tobacco smoking, however, showed a clear, dose-response shaped association with stroke.

Increased Risk of Stroke in Patients of Concussion: A Nationwide Cohort Study

“…The misclassification bias corrected risk ratio was calculated under the assumption of sensitivity of visit for concussion follows a uniform distribution ranging from 80% to 100% (i.e., 80% of patients will visit a doctor) and the specificity of concussion visit follows a uniform distribution ranging from 50% to 100% (i.e., 50% of visits were over-diagnosed as concussion). The median smoking-adjusted stroke incidence rate ratio was calculated under the assumption of a prevalence ranging from 15% to 18% and risk ratio for any stroke episode for smokers ranging from 1.61 to 9.06 [18]. Both bias corrected and smoking-adjusted incidence rate ratio were compared to observed incidence rate ratios to quantify the effect of bias.…”

Associations Between Marijuana Use and Cardiovascular Risk Factors and Outcomes

“…Two prospective studies examined the effect of marijuana exposure on stroke and transient ischemic attack (35, 36). One study (moderate ROB), based on CARDIA, reported that marijuana was not associated with stroke (adjusted HR, 0.65 [CI, 0.16 to 2.66]; P = 0.76); however, the exposure was minimal (median lifetime of 0.51 marijuana-years or 50 times) and the population was young and healthy (35).…”

“…They were followed until age 59 to assess the initial occurrence of stroke. No association between cannabis use and stroke (HR, 0.93 [CI, 0.34 to 2.57]) was identified, but the study was limited by potential misclassification of the exposure, given that it was not reassessed over 25 years of follow-up and adjustment for baseline characteristics was inadequate (36). …”

Uncommon Association of Two Anatomical Variants of Cerebral Circulation: A Fetal-Type Posterior Cerebral Artery and Inferred Artery of Percheron, Complicated with Paramedian Thalamomesencephalic Stroke—Case Presentation and Literature Review

“…Posterior TPAs arise from the superior, posterior, or posterosuperior surfaces of P1. Their morphological diversity and branching patterns, with multiple variations and complex courses, were subject of autopsy studies [ 7 – 17 ] and structural imaging scans [ 18 – 37 ], respectively.…”