Just about half the country has legalized recreational cannabis, with at least some more states likely to consider it in the near future. But as enjoyable as cannabis can be for many, research out today may highlight a possible drawback of the drug: a higher risk of cardiovascular problems.

Researchers in Boston looked at hospitalization rates in parts of the country that legalized cannabis earlier than others. Compared to the pre-legalization era and to non-adopters, rates of several cardiovascular outcomes—including heart attacks—rose in the western half of the U.S. that first adopted recreational cannabis, they found. Though this study isn’t definitive proof that cannabis can cause heart trouble, it’s the first study to explicitly link the expansion of legal cannabis to such issues, the researchers say.

“Our findings point to potential adverse effects of recreational legalization on population health,” the authors wrote in their study, published today in the journal BMJ Open.

Numerous studies and case reports in recent years have tied cannabis use to a higher risk of cardiovascular diseases. Yet other studies have failed to find any link, and some have even suggested that certain ingredients in cannabis like cannabidiol can actually lower blood pressure.

According to the researchers, studying the possible health effects of cannabis through the lens of legalization can offer some advantages over studies that look at individual-level cannabis use. People who use cannabis might differ in other important and not-so-easily visible ways that could affect their risk of certain health problems from people who don’t use it, for instance.

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