Abstract
Cannabis is increasingly used worldwide, yet its cardiovascular effects remain incompletely understood. Emerging evidence suggests that chronic cannabis use may contribute to coronary artery disease (CAD) through hemodynamic stress, endothelial dysfunction, and proinflammatory pathways. We present a report of two patients with significant CAD and long-term daily cannabis use, highlighting its potential role as a modifiable cardiovascular risk factor. We describe two patients with long-term daily cannabis use and significant CAD. The first was a 34-year-old man with minimal traditional cardiovascular risk factors who presented with acute chest pain and was found to have single-vessel disease with an 80% stenosis of the posterior left ventricular branch requiring percutaneous coronary intervention. The second was a 52-year-old man with hypertension, hyperlipidemia, and obesity who presented with exertional chest pain and was found to have severe multivessel disease requiring referral for coronary artery bypass grafting. Both patients reported daily cannabis use for over 17 years. The first case demonstrates significant CAD in a young adult with few conventional risk factors, suggesting cannabis as a potential contributing factor. The second case illustrates severe multivessel disease in a patient with traditional risk factors, where long-term cannabis exposure may have accelerated disease progression. These cases align with current epidemiologic and mechanistic evidence linking chronic cannabis use to endothelial dysfunction, oxidative stress, and atherogenesis. Clinicians should inquire about cannabis use during cardiovascular risk assessments and consider its potential contribution to CAD, particularly in younger adults or in patients with unexpectedly severe disease. While causality cannot be definitively established from case reports, these cases support the need for further research into the long-term cardiovascular effects of chronic cannabis use.