title: Recreational marijuana use and acute ischemic stroke: A population-based analysis of hospitalized patients in the United States.
abstract: BACKGROUND
  Recreational marijuana use is considered to have few adverse effects. However, recent evidence has suggested that it precipitates cardiovascular and cerebrovascular events. Here, we investigated the relationship between marijuana use and hospitalization for acute ischemic stroke (AIS) using data from the largest inpatient database in the United States.
  
  
  METHODS
  The Nationwide Inpatient Sample was queried from 2004 to 2011 for all patients (age 15-54) with a primary diagnosis of AIS. The incidence of AIS hospitalization in marijuana users and non-marijuana users was determined. We utilized multivariable logistic regression analyses to study the independent association between marijuana use and AIS.
  
  
  RESULTS
  Overall, the incidence of AIS was significantly greater among marijuana users compared to non-users (Relative Risk [RR]: 1.13, 95% CI: 1.11-1.15, P<0.0001) and had the greatest difference in the 25-34 age group (RR: 2.26, 95% CI: 2.13-2.38, P<0.0001). Marijuana use was more prevalent among younger patients, males, African Americans, and Medicaid enrollees (P<0.0001). Marijuana users were more likely to use other illicit substances but had less overall medical comorbidity. In multivariable analysis, adjusted for potential confounders, marijuana (Odds Ratio [OR]: 1.17, 95% CI: 1.15-1.20), tobacco (OR: 1.76, 95% CI: 1.74-1.77), cocaine (OR: 1.32, 95% CI: 1.30-1.34), and amphetamine (OR: 2.21, 95% CI: 2.12-2.30) usage were found to increase the likelihood of AIS (all P<0.0001).
  
  
  CONCLUSIONS
  Among younger adults, recreational marijuana use is independently associated with 17% increased likelihood of AIS hospitalization.
authors.affiliation: University of Missouri-Kansas City, School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA. Electronic address: kr899@mail.umkc.edu.
authors.forename: Kavelin
authors.initials: K
authors.lastname: Rumalla
authors.affiliation: University of Missouri-Kansas City, School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA. Electronic address: ar2dc@mail.umkc.edu.
authors.forename: Adithi Y
authors.initials: AY
authors.lastname: Reddy
authors.affiliation: University of Kansas Medical Center, Department of Neurology, Landon Center, 3599 Rainbow Blvd, MS 2012, Kansas City, KS 66160, USA. Electronic address: mmittal2@kumc.edu.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Mittal
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D017677:Age Distribution; D000367:Age Factors; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology*; D018672:Community Health Planning; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology* / Q000208:ethnology; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D013287:Illicit Drugs
keywords: Cannabis; Epidemiology; Marijuana; Nationwide inpatient sample; Stroke; Toxicology