Cannabis use and cardiovascular, renal, and mortality outcomes in patients with type 2 diabetes receiving GLP-1 receptor agonists: A propensity score-matched cohort study.

Authors

Aseel Salameh, Tsung-Ying Yu, Wei-Cheng Chang, Hong-Jie Jhou, Hsin-Yu Chen, Li-Ting Kao, Tina Yi-Jin Hsieh, Ming-Shen Dai, Po-Huang Chen, Cho-Hao Lee

Published in

Drug and alcohol dependence. Volume 286. Pages 113296. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

Cannabis use is rising among adults with type 2 diabetes mellitus (T2DM). Whether cannabis use modifies the cardio-renal benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is unknown.
Retrospective propensity score-matched cohort study in the TriNetX Research Network (January 2017-December 2025). Adults with T2DM initiating GLP-1 RA therapy were classified as people who use cannabis (≥2 ICD-10-CM F12.x codes within 2 years before index) or as people who did not (the comparison cohort). 1:1 matching was performed on more than 40 baseline covariates. The primary outcome was all-cause mortality; secondary outcomes were 4-point major adverse cardiovascular events (MACE) and major adverse kidney events (MAKE). Cox models estimated hazard ratios (HRs); E-values assessed robustness to unmeasured confounding.
Among 614,333 eligible patients, 4117 people who use cannabis were matched to 4117 comparison patients (median follow-up 2.6 years). Cannabis use was associated with increased all-cause mortality (HR 1.64, 95% CI 1.38-1.96), MACE (HR 1.42, 1.26-1.59), and MAKE (HR 1.55, 1.34-1.79). A dose-response was observed: cannabis use disorder (HR 2.20) conferred greater mortality risk than non-disordered use (HR 1.73). Associations persisted across sensitivity and subgroup analyses; E-values were 2.21-2.63. In an exploratory analysis, concomitant sodium-glucose cotransporter-2 (SGLT-2) inhibitor therapy was associated with lower mortality (HR 0.62, 0.45-0.85) and MAKE (HR 0.70, 0.54-0.92) in this group.
Cannabis use was associated with substantially higher mortality, cardiovascular, and renal risk among patients with T2DM initiating GLP-1 RAs, with a dose-response pattern. Clinicians should inquire about cannabis use when prescribing GLP-1 RAs.

PMID:
42546368
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.