Recreational drinking, smoking and drug use is linked to premature heart disease in young people, particularly younger women, according to research published online by the journal Heart, published by BMJ – the British Medical Journal. People who regularly use four or more substances appear nine times as likely to be affected.
The numbers of new cases of heart disease (atherosclerotic cardiovascular disease) have been increasing in young adults, but the potential role of recreational substance use isn’t entirely clear, says researchers from Baylor College of Medicinein the United States and the Aga Khan University, Karachi, in Pakistan in the article published on 15 February 2021.
To probe this further, the researchers explored whether the recreational use of tobacco, cannabis, alcohol and illicit drugs, such as amphetamine and cocaine, might be linked to prematurely and extremely prematurely furred up arteries.
They drew on information supplied to the 2014-2015 nationwide Veterans Affairs Healthcare database and the Veterans with premaTure AtheroscLerosis (VITAL) registry.
Extremely premature heart disease was defined as an ‘event’, such as a heart attack, angina, or stroke before the age of 40, while premature heart disease was defined as an event before the age of 55 in men and before the age of 65 in women.
In all, there were 135,703 people with premature heart disease and 7,716 with extremely premature heart disease. They were compared with 1,112,455 patients who didn’t have premature heart disease.
Recreational use of any substance was independently associated with a higher likelihood of premature and extremely premature heart disease.
Patients with premature heart disease were more likely to smoke (63% vs 41%), drink (32% vs 15%), and to use cocaine (13% vs 2.5%), amphetamines (3% vs 0.5%), and cannabis (12.5% vs 3%).
After accounting for potentially influential factors, such as high blood pressure, diabetes and high cholesterol, those who smoked tobacco were nearly twice as likely to have premature heart disease while those who drank recreationally were 50% more likely to do so.
Cocaine users were almost 2.5 times as likely to have premature heart disease, while those who used amphetamines were nearly three times as likely to do so. Cannabis users were more than 2.5 times as likely to have premature heart disease while those using other drugs were around 2.5 times as likely to do so.
The higher the number of substances used recreationally, the greater was the risk of premature heart disease, ranging from a doubling in risk with the use of one substance to a nine-fold heightened risk for those using four or more.
Similar trends were observed among those who had extremely premature heart disease, with recreational substance use associated with 1.5 to three times higher odds of heart disease.
The associations were even stronger among women with premature and extremely premature heart disease than among similarly affected men.
This is an observational study, and as such cannot establish causality. And the researchers acknowledge that they were unable to gather information on other potentially influential factors, such as the dose and duration of recreational substance use.
In a linked editorial in Heart, Dr Anthony Wayne Orr of LSU Health Shreveport in Louisiana points out that use of cocaine and methamphetamine have been associated with faster cell ageing and neurocognitive decline, with higher than average loss of grey matter.
And epidemiological studies suggest that one in five young adults misuse several substances and that these ‘polysubstance users’ often start using at younger ages, and so have worse health over the long term, he says.
The growing body of published research on these issues “suggests the need for a nationwide education campaign on the potential long-term damage being done to the cardiovascular system in patients with substance use disorders,” he argues.
These people need to be aware of the long term consequences for their health beyond the risk of an overdose, while doctors should screen patients with a history of substance misuse, he says.
“We are only young once, and we should do everything in our power to maintain that state as long as we can,” he concludes.
Recreational substance use among patients with premature atherosclerotic cardiovascular disease
Dhruv Mahtta, David Ramsey, Chayakrit Krittanawong, Mahmoud Al Rifai, Nasir Khurram, Zainab Samad, Hani Jneid, Christie Ballantyne, Laura A Petersen and Salim S Virani
Author affiliations: Michael E DeBakey VA Medical Center; Baylor College of Medicine, Houston; Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital; and the Aga Khan University, Karachi, in Pakistan
Published in the journal Heart on 15 February 2021.
Objective Despite an upsurge in the incidence of atherosclerotic cardiovascular diseases (ASCVD) among young adults, the attributable risk of recreational substance use among young patients has been incompletely evaluated. We evaluated the association of all recreational substances with premature and extremely premature ASCVD.
In a cross-sectional analysis using the 2014–2015 nationwide Veterans Affairs Healthcare database and the Veterans wIth premaTure AtheroscLerosis (VITAL) registry, patients were categorised as having premature, extremely premature or non-premature ASCVD.
Premature ASCVD was defined as having first ASCVD event at age <55 years for men and <65 years for women. Extremely premature was defined as having first ASCVD event at age <40 years while non-premature ASCVD was defined as having first ASCVD event at age ≥55 years for men and ≥65 years for women.
Patients with premature ASCVD (n=135 703) and those with extremely premature ASCVD (n=7716) were compared against patients with non-premature ASCVD (n=1 112 455). Multivariable logistic regression models were used to study the independent association of all recreational substances with premature and extremely premature ASCVD.
Compared with patients with non-premature ASCVD, patients with premature ASCVD had a higher use of tobacco (62.9% vs 40.6%), alcohol (31.8% vs 14.8%), cocaine (12.9% vs 2.5%), amphetamine (2.9% vs 0.5%) and cannabis (12.5% vs 2.7%) (p<0.01 for all comparisons).
In adjusted models, the use of tobacco (OR 1.97, 95% CI 1.94 to 2.00), alcohol (OR 1.50, 95% CI 1.47 to 1.52), cocaine (OR 2.44, 95% CI 2.38 to 2.50), amphetamine (OR 2.74, 95% CI 2.62 to 2.87), cannabis (OR 2.65, 95% CI 2.59 to 2.71) and other drugs (OR 2.53, 95% CI 2.47 to 2.59) was independently associated with premature ASCVD.
Patients with polysubstance use had a graded response with the highest risk (~9-fold) of premature ASCVD among patients with use of ≥4 recreational substances. Similar trends were observed among patients with extremely premature ASCVD.
Gender interactions with substance use were significant (p-interaction <0.05), with recreational substance use and premature ASCVD showing stronger associations among women than in men with premature ASCVD.
All subgroups of recreational substances were independently associated with a higher likelihood of premature and extremely premature ASCVD. Recreational substance use confers a greater magnitude of risk for premature ASCVD among women.
A graded response relationship exists between increasing number of recreational substances used and higher likelihood of early-onset ASCVD.
Young at heart? Drugs of abuse cause early-onset cardiovascular disease in the young
Matthew L Scott, Kevin S Murnane and Anthony Wayne Orr
Author affiliation: LSU Health Shreveport in Louisiana, United States
Published in the journal Heart on 15 February 2021.
We are all familiar with them, from alcohol and tobacco to methamphetamine and cannabis. While drugs of abuse are often used as important medications (eg opioids for pain management), the non-medical use of these substances has been trending upward globally, which is likely to be accelerated by the global coronavirus pandemic and its concomitant mental health crisis.
There has been a particularly notable increase in the abuse of synthetic opioids (eg fentanyl) and stimulants (eg methamphetamine), with growing evidence of an epidemic of simultaneous polysubstance abuse of opioids with methamphetamine.
In the USA, the emerging methamphetamine crisis has led to congressional introduction of the Methamphetamine Response Act to forestall or prevent the development of this crisis in its early stages.
Substance use and premature cardiovascular disease
Since the advent of antibiotics in the early 20th century, cardiovascular disease has been the leading cause of death in the USA. While therapeutic advances have reduced the incidence of cardiovascular diseases over the past 30 years, we have recently seen an uptick in the incidence of cardiovascular disease.
Although prevalent in the aged population, atherosclerotic cardiovascular diseases (ASCVDs), such as ischaemic heart disease (IHD), ischaemic cerebrovascular disease and peripheral arterial disease, have shown an alarming rise in young patients. However, the causal factors contributing to this premature ASCVD remain undefined.
Substance use disorders have been associated with an acceleration of the ageing process. Use of cocaine and methamphetamine have been associated with accelerated cellular ageing and neurocognitive decline with greater than normal age-related cortical grey matter loss.
In parallel to accelerated ageing, growing evidence suggests that the substance use disorder epidemics may accelerate vascular ageing and contribute to early-onset ASCVD. Cannabis use has been associated with accelerated cardiovascular ageing, and cardiovascular ageing has been viewed as a surrogate for organismal ageing…continues but access is restricted.
BMJ – British Medical Journal material – Drinking, smoking, and drug use linked to premature heart disease in the young (Open access)
Heart journal article – Recreational substance use among patients with premature atherosclerotic cardiovascular disease (Restricted access)
Heart journal editorial – Young at heart? Drugs of abuse cause early-onset cardiovascular disease in the young (Restricted access)
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