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Use of Methamphetamines Raises Risk of Heart Failure

December 4, 2017
Rate of heart failure quadrupled among veterans who were regular methamphetamines users.

With Marin Nishimura, MD, and Michael Clark, MD, MPH, MBA

Granted, methamphetamine use remains a serious problem throughout the United States with more than 5.4% of the population over age 12 years (and 6.5 of adults ages 26 and older) admitting to having tried the addictive stimulant at least once,1 according to the National Institute on Drug Abuse.

According to researchers from the University of California at San Diego  (UC), an alarming rise in the rate of heart failure is occurring among veterans who have become regular methamphetamine users.2

High Use of Meth among Vets quadruples their risk for heart failure.Methamphetamine abuse raises risk of heart failure among vets.

Following 9,588 patients at the San Diego VA Medical Center who were diagnosed with heart failure between 2005 and 2015,2 said Marin Nishimura, MD, an internal medicine resident at UC/San Diego who presented the study of heart failure risk among veterans at the American Heart Association Scientific Session in Anaheim, California on November 14, 2017. Among these patients, 480 had a history of documented methamphetamine abuse.2

The proportion of vets who were taking methamphetamines regularly and experienced heart failure rose from 1.7% at the beginning to the study to 8% some ten years later.2

"We anticipated an increase in prevalence but It more than quadrupled," Dr. Nishimura told Practical Pain Management, and "we found important differences between the two groups [meth users and non- meth users]."

Distinct Characteristics May Explain Risk

Both groups had similar levels of heart function or ejection fraction,2 Dr. Nishimura said

The researchers found two distinct phenotypes—reduced ejection fraction and preserved ejection fraction in those meth users with heart failure. However, there were important differences between the groups, as well. Meth users were less likely to be diagnosed with atrial fibrillation and were less likely to have significant coronary artery disease.2

Perhaps surprisingly, methamphetamine users with heart failure were younger—age 61 on average--compared to a mean age of 72 years among non-methamphetamine users.

In addition, “they were more likely to be homeless and unemployed,” Dr. Nishimura said, “and to have psychiatric comorbidities such as post-traumatic stress disorder (PTSD) and depression.”

The heart failure patients who had a history of methamphetamine abuse used the emergency department more often, as well as demonstrating a greater need for psychiatric care and addiction services after they were discharged from the hospital.2

Dr. Nishimura had no information regarding the reason behind the patients’ use of methamphetamines. However, their use of meth was identified by an ICD9 code for methamphetamine abuse in their medical chart, by a positive toxicology urine screen, or a notation regarding a previous hospitalization for treatment for a methamphetamine abuse disorder as the primary reason for hospitalization.2

The findings were based only data from only one center, so additional research is needed to confirm the prevalence rates against those found by Dr. Nishimura’s research team.

 Expert Perspective on the Study Findings

About 5.7 million Americans have been diagnosed with heart failure,according to estimates from the Centers for Disease Control and Prevention, and half of patients will die within five years of their initial diagnosis.3

The new research ''documents yet another serious risk of illicit drug use," said Michael R. Clark, MD, MPH, MBA, director of the Pain Treatment Program at Johns Hopkins University, Baltimore.

“The link found by the researchers should be viewed as follows: those who abuse meth are at greater risk for heart failure, not that heart failure patients are at greater risk for using methamphetamine,” he told Practical Pain Management.

How to Handle At-Risk Patients

The message for pain practitioners is this, said Dr. Nishimura, "When you see an otherwise healthy young person who comes in with heart failure, suspect meth use."

Once it is established that a patient has a history of methamphetamine use and has been diagnosed with heart failure, it is crucial to address other domains, she said, particularly psychiatric comorbidities such as post-traumatic stress disorder, and chronic pain conditions.

"If the patient quits [the meth], there is pretty good evidence from animal models that the patient’s heart will recover," she said, "But before they will be able to give up their meth use, practitioners have to address the underlying issues that may be cause of their dependence on meth."

While Dr. Clark agreed, he stressed the urgent need to "counsel your patients at risk for using illicit substances or who may be using meth since we now know they are at increased risk for heart failure. For patients who have already experienced heart failure and have the risk factors associated with meth use, clinicians should be asking about whether the patient is using meth and confirm the responses with a urine toxicology screen for added measure.” 

Finally, he said, “it is worth considering that the increasing restrictions on opioid use may result in more illicit drug use such as heroin and meth.''  Given the cost and convenience, it should not be surprisingly that so many patients are turning to these readily available street drugs to sooth their pains.

Dr. Nishimura and Dr. Clark reported no financial disclosures. 

Last updated on: December 19, 2017
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New definition of addiction may lead to additional treatment options of pain medication abusers

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