Misuse of methamphetamines increases the risk of adverse heart health outcomes

According to a recent study, methamphetamine abuse is linked to cardiovascular damage on a scale comparable to decades of alcohol and cocaine abuse.

There were increased risks of several forms of cardiovascular disease (CVD), including pulmonary hypertension (PH), heart failure (HF), stroke and myocardial infarction with obstructive coronary artery disease (MI), myocardial infarction with non-obstructive coronary arteries (MINOCA), MI plus MINOCA and overall CVD load.

The study was conducted on a population of hospitalized patients in California who reported a history of use between 2005 and 2011 and published in Journal of the American Heart Association.

“Its deleterious effect on the cardiovascular system is believed to be multifactorial; a combination of excessive catecholamine release leading to hypertension, tachycardia and coronary vasospasm, as well as the direct cytotoxic effect of increased reactive oxygen species and mitochondrial damage of cardiac myocytes, “the authors wrote.

“It is therefore crucial to better understand the burden of disease associated with methamphetamine misuse and to identify the key factors leading to its development in order to identify goals for prevention and treatment in this high-risk group.”

Study data was provided by the Healthcare Cost and Utilization Project database, of which over 20 million patients, 0.3% reported methamphetamine use on a median follow-up (IQR) of 4.6 ( 3.0-6.4) years after receiving care in hospital, emergency room, or surgery and outpatient services.

Overall, 53% and 42% higher risks for HF (HR, 1.53; 95% CI, 1.45-1.62) and PH (HR, 1.42; 95% CI) were evident in the study population. , 1.26-1.60), respectively. Notably, among male study participants, the risk of myocardial infarction was particularly high, at 73%, compared to female participants (HR, 1.73; 95% CI, 1.37-2.18). .

Chronic kidney disease (CKD) (HR, 2.38; 95% CI, 1.74-3.25), PH (HR, 2.26; 95% CI, 2.03-2.51), diabetes (HR , 1.75; 95% CI, 1.55-1.97), smoking status (HR, 1.28; 95% CI, 1.17-1.40), and obesity (HR, 1, 71; 95% CI, 1.44-2.02) were correlated with higher CVD risks among methamphetamine users than non-users. Concomitant cocaine use, in particular, was linked to a higher risk of myocardial infarction and / or MINOCA (HR, 1.45; 95% CI, 1.06-2.00).

The main factors associated with methamphetamine use, compared with those that did not report methamphetamine use, were younger mean (SD) age (33 [11.6] vs 44.9 [19.5] years), male (63.3% versus 44.4% of female patients), cocaine abuse (0.33% versus 0.12%) and alcohol (6.5% versus 0.67%), history of smoking (26.1% vs 3.8%), chronic depression (11.9% vs 1.9%), chronic anxiety (4.7% vs 1.5%) and income quartile (first quartile, 34.20% vs fourth quartile, 14.60%).

In addition, compared with those who did not report the use of the following, the overall 32% increase in CVD risk due to methamphetamine use (HR, 1.32; 95% CI, 1.27-1, 38) was comparable to 28% reporting alcohol abuse specifically (HR, 1.28; 95% CI, 1.26-1.31) or 47% reporting cocaine use (HR, 1.47 ; 95% CI, 1.40-1.54), the study researchers noted. The trend towards higher risk was also evident among the remaining CVD subtypes studied:

  • MI: 19% (HR, 1.19; 95% CI, 1.08-1.31)
  • MI or MINOCA: 10% (HR, 1.10; 95% CI, 1.01-1.21)
  • Stroke: 12% (HR, 1.12; 95% CI, 1.03-1.22)

In clarifying the clinical significance of their findings, the study authors highlighted 3 areas that their findings indicate are important to target: modifiable risk factors (e.g., interaction between CVD and mental health disorders.

“Recognition of the significant burden of methamphetamine-associated CVDs is vital given the rapidly growing use of methamphetamine and related stimulants worldwide,” they concluded. “Further work is also needed to better understand the effect of dose, duration of use and route of administration of methamphetamine on the cardiovascular system.”

Reference

Curran L, Nah G, Marcus GM, Tseng Z, Crawford MH, Parikh NI. Clinical correlations and outcomes of methamphetamine-associated cardiovascular disease in hospitalized patients in California. J Am Heart Assoc. Published online August 1, 2022.doi: 10.1161 / JAHA.121.023663

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