Methamphetamine use linked to 1 in 6 heart attacks in California study

Methamphetamine (meth) use accounted for nearly 15% of heart attacks for a decade in a northern California study, published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

“Even though meth users were generally younger and didn’t have typical cardiovascular disease-related conditions like high cholesterol, Type 2 diabetes or obesity, they were twice as likely to die after a heart attack when compared to non-users,” said study author Susan Zhao, M.D., staff cardiologist and medical director of the Coronary Care Unit at Santa Clara Valley Medical Center in San Jose, California, and an associate clinical professor of medicine (affiliated) at Stanford School of Medicine. “People who use meth need to be aware of the serious health risks associated with it, and medical professionals should closely monitor heart attacks in patients who appear healthy and lack typical risk factors, such as Type 2 diabetes or high cholesterol.”

Methamphetamine, a highly addictive, illegal synthetic central nervous system stimulant, has seen a dramatic increase in use in the U.S. in recent decades. Most meth in the U.S. is illegally made and usually appears as a powder or crystals known as “crystal meth.”

In this study, the largest analysis on acute coronary syndrome (ACS) and methamphetamine use to date, researchers reviewed the medical records of over 1,300 heart attack patients treated at one hospital in Northern California.

The analysis found:

• Meth use accounted for about 1 in 6 heart attacks during the period reviewed.
• People who used meth and had a heart attack were younger (median age 52 years) and were more likely to be male compared to those who had a heart attack but did not use meth (median age 57 years).
• Meth users were less likely to have common risk factors for heart disease, such as high cholesterol and Type 2 diabetes, but were more likely to smoke cigarettes, use alcohol and experience homelessness than heart attack patients in this study who did not use meth.
• Adults who used meth were readmitted to the hospital for repeat heart attacks (42.3%) more often and had a higher risk of death from any cause (22.2%) than people who didn’t use meth (14.4%).
• Only 59.3 % of meth users were likely to have procedures to open clogged arteries or to be sent home with standard heart medications, in part because their heart attacks didn’t involve blocked arteries, compared to 75% of non-meth users.

“As meth use rises on the West Coast of the U.S. and this trend moves eastward, heart attacks associated with meth use will increasingly occur in areas beyond California,” Zhao said. “We want to raise awareness that acute coronary syndrome and meth use affect different groups of people, such as young to middle-aged men without traditional risk factors. These groups have different risk factors and health issues, and they also can have a higher chance of dying from them.

“These findings show that we need specific prevention and treatment plans for meth users - a vulnerable and high-risk group. New plans should also focus on helping people stop using meth,” she said.

Robert L. Page II, Pharm.D., M.S.P.H., FAHA, chair of the writing group for the American Heart Association’s 2020 cannabis statement, said, “As with cannabis, methamphetamine is becoming a major risk factor for developing premature heart disease in young adults, which can lead to serious cardiovascular events. It is important to understand that methamphetamine can harm the heart by causing issues like damaged blood vessels and increased aging of the vascular system.

Page added, “People who have used methamphetamine are diagnosed with heart disease about 8 years earlier than those who haven’t used it. Research shows that men are more likely to have heart attacks related to methamphetamine, and women may also be more vulnerable to heart disease from using stimulants compared to women who don’t use them. These findings highlight the need for health care professionals to discuss these serious risks with their patients to emphasize the potential harms of stimulant abuse.” Page is also a professor in the department of clinical pharmacy and the department of physical medicine/rehabilitation at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences in Aurora, Colorado, and was not a part of this study.

Study design, details and background:

• The study was conducted at Santa Clara Valley Health Care (SCVH), a public safety-net hospital in Northern California, and included 1,309 adults aged 18 to 65 who were treated for heart attacks between 2012 and 2022, among whom were 194 people who were meth users.
• Meth use was determined by reviewing electronic records for substance abuse reported by patients and results from urine tests.
• Of the heart attack patients who were meth users, about 15% were women; half were white adults; and 25% of patients self-reported they were of Hispanic ethnicity.
• The study excluded heart attack patients with aortic disease, congenital heart disease, heart inflammation, spreading cancer, trauma, type 2 heart attack (heart muscle does not get enough oxygen due to a mismatch between supply and demand, rather than a direct blockage in a coronary artery), valve disease or cocaine users.

The study might not be able to fully show the impact of meth on heart attacks because not all heart attack patients are screened for drug use, or because some cases of meth-induced cardiac events might be incorrectly classified in hospital records. Other limitations include that the study is a review of health records and includes patients treated for heart attack at a single hospital, so the results may not apply to other population groups or patients treated at other hospitals.

Reference:

Susan X. Zhao, William Xu, Mark Jaradeh, Methamphetamine Use Among Adult Patients Presenting With Acute Coronary Syndrome: A Single‐Center Retrospective Cohort Study, Journal of the American Heart Association, https://doi.org/10.1161/JAHA.125.046514