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This study aimed to determine the association between lifetime exposure to marijuana and measures of subclinical atherosclerosis in mid\u2010life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and participants<\/jats:title><jats:p>We used data from the US\u2010based Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of black and white men and women aged 18\u201330\u00a0years at baseline in 1985\u201386, with up to seven follow\u2010up examinations over 25\u00a0years. A total of 3498 participants in the CARDIA study were included in this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Cumulative years of exposure to marijuana (expressed in \u2018marijuana\u2010years\u2019, with 1 marijuana\u2010year equivalent to 365\u00a0days of use) using repeated assessments every 2\u20135\u00a0years for 25\u00a0years. Abdominal artery calcium (AAC) and coronary artery calcium (CAC) scores were measured by computed tomography at year 25 examination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 3117 participants with AAC and CAC measurements, 2627 (84%) reported past marijuana use and 1536 (49%) past daily tobacco smoking. Compared with tobacco smokers, 46% of whom reported 10 or more pack\u2010years of use, only 12% of marijuana users reported 5 or more marijuana\u2010years of use and only 6% reported having used marijuana daily. We found a significant interaction between never and ever tobacco users on the association between cumulative marijuana use and AAC (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.05). Among those who never smoked tobacco, cumulative marijuana\u2010years were not associated with AAC or CAC in models adjusted for demographics, cardiovascular risk factors, licit and illicit drug exposure and depression symptoms. However, among ever tobacco smokers, marijuana exposure was associated with AAC and CAC. At 5 marijuana\u2010years of exposure, using AAC\u00a0=\u00a00 and CAC\u00a0=\u00a00 as a reference group, the odds ratio (OR) was 1.97 [95% confidence interval (CI)\u00a0=\u00a01.21\u20133.21, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.007] for AAC\u00a0&gt;\u00a00\/CAC\u00a0=\u00a00 and 1.83 (95% CI\u00a0=\u00a01.02\u20133.31, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04) for CAC\u00a0&gt;\u00a00), regardless of AAC. Tobacco smoking was associated strongly with both AAC and CAC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Marijuana use appears to be associated with subclinical atherosclerosis, but only among ever tobacco users.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.14110","type":"journal-article","created":{"date-parts":[[2017,11,23]],"date-time":"2017-11-23T03:36:39Z","timestamp":1511408199000},"page":"845-856","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Lifetime marijuana use and subclinical atherosclerosis: the Coronary Artery Risk Development in Young Adults (CARDIA) study"],"prefix":"10.1111","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4222-4849","authenticated-orcid":false,"given":"Reto","family":"Auer","sequence":"first","affiliation":[{"name":"Institute for Primary Health Care (BIHAM) University of Bern  Bern Switzerland"},{"name":"Department of Ambulatory Care and Community Medicine University Hospital  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Sidney","sequence":"additional","affiliation":[{"name":"Division of Research Kaiser Permanente Northern California  Oakland CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Goff","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute  Bethesda MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Vittinghoff","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of San Francisco  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Pletcher","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics University of San Francisco  San Francisco CA USA"},{"name":"Department of Medicine University of San Francisco  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norrina B.","family":"Allen","sequence":"additional","affiliation":[{"name":"Northwestern University  Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared P.","family":"Reis","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute  Bethesda MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cora E.","family":"Lewis","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham  Birmingham AL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Carr","sequence":"additional","affiliation":[{"name":"Vanderbilt University  Nashville TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal S.","family":"Rana","sequence":"additional","affiliation":[{"name":"Department of Cardiology Kaiser Permanente Northern California  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