Peripheral cannabinoid CB1 receptor antagonists that lack central
nervous system effects are emerging as promising therapies for metabolic
disease, yet the role of endothelial CB1 signaling in atherosclerosis
remains unclear. Here, we show that endothelial CB1 is expressed in
human atherosclerotic plaques, is induced by oscillatory shear stress in
atheroprone flow regions, and promotes vascular inflammation,
permeability and lipid uptake. Endothelial-specific Cnr1 deletion
or peripheral CB1 antagonism in mice attenuates atherosclerosis,
reduces endothelial caveolae–dependent low-density lipoprotein uptake by
downregulating caveolin-1 and ALK1 expression, and improves metabolic
parameters in brown and white adipose tissue and the liver. The
anti-atherogenic and metabolic effects are more pronounced in females,
which is possibly linked to estrogen signaling. These findings identify
endothelial CB1 as a proatherogenic, sex-biased regulator of vascular
lipid transport and plaque development and associated metabolic
dysfunction.