Lifetime Cannabis, Non-Cigarette Tobacco, and Illicit Drug Use and Cardiovascular Disease Among Young and Middle-Aged U.S. Adults

<b>Background:</b> Despite increases in cardiovascular disease (CVD) prevalence among young and middle-aged adults in the United States (U.S.), associations between lifetime use of cannabis, non-cigarette tobacco products, and illicit drugs with CVD are not fully known. This study aimed to examine these associations among young and middle-aged U.S. adults. <b>Methods:</b> We analyzed a sample of 2933 adults aged 20-59 years from the National Health and Nutrition Examination Survey (2017-2018). CVD (i.e., health care provider diagnosis of coronary heart disease, stroke, or high blood pressure), and substance use (i.e., ever use of cannabis, non-cigarette tobacco, or illicit drugs) were assessed. Adjusted odds ratios were estimated using multivariable logistic regression. <b>Results:</b> Adults who used cannabis had higher odds of coronary heart disease (OR = 5.45, 95% CI: 1.86-15.95), and adults who used cigars had higher odds of stroke (OR = 2.31, 95% CI: 1.06-5.01). Further, increased odds of high blood pressure were associated with e-cigarette (OR = 1.41, 95% CI: 1.12-1.79) and smokeless tobacco (OR = 1.46, 95% CI: 1.01-2.12) use. <b>Conclusions:</b> Lifetime cannabis and non-cigarette use was associated with CVD among young and middle-aged U.S. adults, with the spectrum of disease varying based on substance type. CVD prevention should involve non-cigarette tobacco and cannabis use screening and counseling.