Methamphetamine Misuse Increases Risk of Adverse Heart Health Outcomes

Methamphetamine misuse is linked to cardiovascular damage on a scale comparable to decades-long abuse of alcohol and cocaine, according to a recent study.

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 nonobstructive coronary arteries (MINOCA), MI plus MINOCA, and overall CVD burden.

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

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

“It is therefore vital that we better understand the disease burden associated with methamphetamine misuse and identify the key factors that lead to its development, in order to identify targets for prevention and treatment in this high-risk group.”

The study data were provided by the Healthcare Cost and Utilization Project database, among whose 20 million–plus patients 0.3% reported use of methamphetamines over a median (IQR) follow-up of 4.6 (3.0-6.4) years after they received care in the inpatient, emergency department, or ambulatory surgery and services settings.

Overall, 53% and 42% higher risks were evident among the study population for HF (HR, 1.53; 95% CI, 1.45-1.62) and PH (HR, 1.42; 95% CI, 1.26-1.60), respectively. Specifically, among the male study participants, the risk for MI was especially elevated, at 73%, compared with 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) correlated with higher risks of CVD among methamphetamine users vs nonusers. Concomitant cocaine use, in particular, was linked to a higher risk of MI and/or MINOCA (HR, 1.45; 95% CI, 1.06-2.00).

Top factors associated with methamphetamine use, vs those not reporting methamphetamine use, were mean (SD) younger age (33 [11.6] vs 44.9 [19.5] years), male gender (63.3% vs 44.4% of female patients), coexisting cocaine (0.33% vs 0.12%) and alcohol (6.5% vs 0.67%) abuse, smoking history (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%).

Further, compared with those not reporting use of the following, the overall 32% increased risk of CVD from methamphetamine (HR, 1.32; 95% CI, 1.27-1.38) use was comparable to the 28% specifically reporting alcohol abuse (HR, 1.28; 95% CI, 1.26-1.31) or the 47% reporting cocaine use (HR, 1.47; 95% CI, 1.40-1.54), highlighted the study investigators. The trend of higher risk was evident, too, among the remaining CVD subtypes investigated:

• 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)

When clarifying the clinical significance of their findings, the study authors highlighted 3 areas their results indicate are important to target: modifiable risk factors (eg, CKD, hypertension, diabetes), CVD treatments that improve PH- and HF-related outcomes, and the interplay of CVD and mental health disorders.

“The recognition of the significant burden of methamphetamine-associated CVD 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 correlates and outcomes of methamphetamine‐associated cardiovascular diseases in hospitalized patients in California. J Am Heart Assoc. Published online August 1, 2022.doi: 10.1161/JAHA.121.023663