Cannabis Use Disorder Is Associated With Increased Risk of Acute Myocardial Infarction in Adults With Metabolic Dysfunction-Associated Steatohepatitis (MASH) Cirrhosis: A Population-Based Analysis

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INTRODUCTION: Cannabis use disorder (CUD) is encountered among hospitalized adults with metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis. Both conditions are independently associated with adverse cardiometabolic profiles, raising concern for potential cardiovascular complications when they coexist. This study evaluated the association between CUD and acute myocardial infarction (MI) among hospitalized adults with MASH cirrhosis. METHODS: We performed a retrospective cross-sectional analysis of the National Inpatient Sample from 2016 to 2020, including adults aged ≥18 years hospitalized with MASH cirrhosis. CUD was identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Multivariable logistic and Poisson regression models were used to examine associations between CUD and acute MI, in-hospital mortality, major adverse cardiovascular events, hepatic decompensation, length of stay, and hospitalization costs, adjusting for demographics, comorbidities, and hospital characteristics. RESULTS: Among 57,754 hospitalizations for MASH cirrhosis, 539 involved patients with CUD. CUD was associated with a significantly higher likelihood of acute MI (adjusted odds ratio 2.18; 95% CI 1.30-3.63). No significant associations were observed between CUD and in-hospital mortality or overall major adverse cardiovascular events. CUD was associated with lower odds of hepatic decompensation. Hospitalizations involving CUD were associated with lower adjusted costs, while length of stay did not differ significantly between groups. CONCLUSION: Among hospitalized adults with MASH cirrhosis, CUD was associated with a higher risk of acute MI but not with increased in-hospital mortality or overall major adverse cardiovascular events. These findings underscore the importance of cardiovascular risk assessment and CUD identification in this population. As this was an observational cross-sectional study, the findings represent associations and do not establish causality.