(717) The Association of Marijuana Use With Ischemic Stroke and Spontaneous Intracerebral Hemorrhage

Introduction: While marijuana use has been associated with myocardial infarction and coronary artery disease, there is limited data on its association to cerebrovascular diseases. Given the absence of data, our aim was to analyze whether proximate marijuana use is associated with the development of ischemic stroke (IS) or spontaneous intracerebral hemorrhage (sICH) after legalization in Illinois in 2020. We hypothesized that marijuana was associated with IS and sICH.

Methods: Between January/2011 to December/2023, we retrospectively identified patients admitted to our medical center with a diagnosis of IS and primary sICH (defined as hypertensive or related to cerebral amyloid angiopathy based on consensus diagnosis) using the Get with Guidelines database. Sociodemographic data including age, gender, race, and ethnicity were recorded. Proximate marijuana was defined as a positive result on a urine toxicology screen obtained within 48 hours of admission. Multivariable logistic regressions were performed comparing IS and sICH patients and marijuana positivity. Covariates included admission time, age, gender, race, and ethnicity.

Results: A total of 4973 patients with a urine toxicology screen were identified, of which 1744 patients were sICH and 3229 patients were IS. The average age was 61.6 years old (SD 14.7), with n=2713 (54.6%) males, n=2240 (45.0%) Black, and n=693 (13.9%) Hispanic. From this cohort, 125 sICH patients (7.2%) and 326 IS patients (10.1%) were positive for marijuana. Patients with IS were more likely to be marijuana positive after legalization (OR 1.62, p=0.001). This did not hold true for patients with sICH (p=0.28). The odds ratio of marijuana positivity before and after legalization was not significantly different between sICH and IS patients (p=0.20). After correcting for age, gender, race, and ethnicity, patients with marijuana positivity on urine toxicology were more likely to be IS patients rather than sICH patients (OR 1.64, p< 0.0001).

Conclusions: Our data suggest that marijuana use may be associated with IS, but not sICH. Further research is warranted to understand the pathophysiologic mechanisms associated between marijuana use and the development of ischemic stroke.