New clinical evidence presented at the Society for Cardiovascular Angiography & Interventions (SCAI) 2025 Scientific Sessions has drawn renewed attention to the growing cardiovascular risks associated with two of the most widely used substances in the United States: tobacco and cannabis. According to researchers, coronary heart disease deaths tied to tobacco use are projected to increase by nearly 44% within the next five years, while people with cannabis use disorder (CUD) are significantly more likely to suffer from serious heart complications including heart attacks and arrhythmias.
The studies — conducted using national datasets and published in JSCAI, SCAI’s official journal — underscore the urgent need for targeted public health interventions and greater awareness of cardiovascular risks among vulnerable populations.
Tobacco-Linked Heart Disease Deaths Set to Soar, Especially Among Black Women and Indigenous Groups
One of the studies, led by Dr. Roopeessh Vempati, an Internal Medicine resident at Trinity Health Oakland and Wayne State University, used mortality data from the CDC-WONDER database covering the years 1999 to 2020 to analyze ischemic heart disease mortality related to tobacco use (IHD-T) in Americans aged 25 and older.
The data revealed a 14-fold increase in annual tobacco-related heart disease deaths, from 4,669 in 1999 to 56,367 in 2020. If current trends continue, projections show deaths could rise to over 80,000 annually by 2030, a 43.7% increase in just a decade.
Dr. Vempati emphasized that these deaths are not evenly distributed across the population. “Our analysis found that risks are not evenly distributed, as Black women experienced the highest annual increases in mortality compared to white women,” he said. “This challenges assumptions and calls for more nuanced, racially and geographically tailored cardiovascular interventions.”
Key findings from the study include:
- American Indian/Alaska Native, Black, and Asian/Pacific Islander populations experienced sharp increases in tobacco-related IHD deaths early in the 2000s.
- White men had the steepest average annual rise in mortality at 12.01%.
- Black women saw a 10.39% average annual increase, underscoring a growing health disparity.
- Overall, all racial groups experienced steady increases in mortality rates due to tobacco-related heart disease, despite ongoing anti-tobacco campaigns.
Dr. James B. Hermiller, President of SCAI, reinforced the significance of the study: “Tobacco-related ischemic heart disease remains a leading killer. These findings quantify its devastating trajectory and give us the data we need to implement targeted, evidence-based public health strategies.”
Access the full study here: https://doi.org/10.1016/j.jscai.2025.103178
Cannabis Use Disorder Increases Risk of Serious Cardiac Events in Heart Failure Patients
A separate but equally concerning study, led by Dr. Syed Ishaq of Sinai Hospital of Baltimore, examined the impact of Cannabis Use Disorder (CUD) on individuals hospitalized for heart failure (HF). Using National Inpatient Sample (NIS) data from 2016 to 2020, researchers analyzed outcomes for more than 1.37 million patients, identifying 19,445 who had both heart failure and a secondary diagnosis of CUD.
The results revealed that while patients with both HF and CUD were 50% less likely to die in the hospital than those without CUD, they faced significantly higher odds of suffering from critical cardiac events:
- 27% more likely to experience cardiogenic shock.
- 50% more likely to suffer acute myocardial infarction (heart attack).
- 48% more likely to develop arrhythmias (irregular heart rhythms).
“These findings were somewhat unexpected,” said Dr. Ishaq. “While the reduced in-hospital mortality was surprising, the dramatically increased risks of secondary complications paint a complex picture of cannabis use in patients with pre-existing heart disease.”
The study suggests that cannabis may exacerbate cardiovascular stress, increasing the risk of acute events like heart attacks and arrhythmias, even as some outcomes like short-term mortality appear less severe. Researchers hypothesize that lower mortality rates may be influenced by younger age and fewer co-morbidities among the CUD group, but caution that chronic exposure to cannabis can still compromise cardiovascular health.
Dr. Ishaq stressed the importance of early clinical intervention: “This understanding is necessary for doctors and public health professionals to warn patients of the long-term cardiovascular effects of consistent cannabis use, even in populations not yet experiencing heart failure.”
Access the full study here: https://doi.org/10.1016/j.jscai.2025.102905
The Broader Public Health Implications
Together, these studies shine a light on the emerging cardiovascular challenges posed by both traditional tobacco use and rising cannabis consumption. With cannabis legalization expanding across U.S. states and globally, experts are warning that public perceptions of cannabis as a ‘safe’ substance may be dangerously misleading — particularly for individuals with pre-existing cardiac conditions.
Moreover, the tobacco-related mortality projections highlight that despite decades of anti-smoking initiatives, the tobacco epidemic remains far from over, and continues to disproportionately impact racial minorities and economically marginalized groups.
“Prevention strategies must be intersectional and community-specific,” said Dr. Vempati. “We need to develop culturally competent interventions, expand access to preventative cardiology, and invest in long-term education campaigns targeting both youth and at-risk adults.”
In the case of cannabis, clinicians are advised to:
- Screen patients for cannabis use and CUD, particularly those with cardiovascular risk factors.
- Offer counseling and education on potential heart risks.
- Monitor heart failure patients closely if cannabis use is ongoing.
For tobacco, recommendations include:
- Renewed cessation support programs targeted at Black women and Indigenous populations.
- Enhanced data surveillance to monitor geographic and demographic trends in IHD-T.
- Expanded insurance coverage for preventive cardiology services.
What Comes Next
SCAI officials say these findings will serve as a foundation for updated clinical guidelines and public health collaborations in the coming year. Both studies point toward the necessity of a multi-disciplinary approach — combining cardiology, addiction medicine, public health, and social advocacy — to curb the dual threats posed by tobacco and cannabis in the context of heart disease.
As Dr. Hermiller concluded, “The challenge before us is not only scientific but societal. If we are to bend the curve of cardiovascular mortality, we must address substance use as a central risk factor, and we must do so with urgency, precision, and compassion.”
