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Drugs of Abuse and Heart Failure
Alex F Grubb1, Stephen J Greene2, Marat Fudim2
1Department of Medicine, Duke University Hospital, Durham, North Carolina.
Insights
Substance use significantly impacts heart failure (HF) outcomes. Understanding the effects of alcohol, tobacco, cannabis, and cocaine is crucial for managing HF patients and improving their cardiovascular health.
Area of Science:
- Cardiology
- Toxicology
- Public Health
Background:
- Substance use is prevalent in heart failure (HF) patients.
- Abuse of alcohol, tobacco, cannabis, and cocaine is linked to adverse cardiovascular events and HF progression.
Purpose of the Study:
- To review the impact of common substances on the development and exacerbation of heart failure.
- To summarize current understanding of substance-specific cardiovascular effects.
Main Methods:
- Literature review of studies investigating substance use and heart failure.
- Analysis of cardiovascular effects of alcohol, tobacco, cannabis, and cocaine.
Main Results:
- Heavy alcohol use can cause dilated cardiomyopathy; moderate use may reduce HF incidence.
- Tobacco use increases HF risk via coronary artery disease and other mechanisms; cessation improves outcomes.
- Cannabis has variable cardiovascular effects; delta-9-tetrahydrocannabinol may increase myocardial infarction risk, while cannabidiol shows preclinical cardioprotection.
- Cocaine use elevates sympathetic tone, increases myocardial infarction risk, and can lead to dilated cardiomyopathy; beta-blockers may be safe in this population.
Conclusions:
- Substance use presents complex challenges in heart failure management.
- Further research is needed to fully understand the interplay between substance use and heart failure development and progression.
Abstract:
Substance use is common among those with heart failure (HF) and is associated with worse clinical outcomes. Alcohol, tobacco, cannabis, and cocaine are commonly abused substances that can contribute to the development and worsening of HF. Heavy alcohol consumption can lead to dilated cardiomyopathy, whereas moderate intake may decrease incident HF. Tobacco increases the risk of HF through coronary artery disease and coronary artery disease-independent mechanisms. Continued smoking worsens outcomes for those with HF and cessation is associated with an improved risk of major adverse cardiac events. Cannabis has complex interactions on the cardiovascular system depending on the method of consumption, amount consumed, and content of cannabinoids. Delta-9-tetrahydrocannabinol can increase sympathetic tone, cause vascular dysfunction, and may increase the risk of myocardial infarction. Cannabidiol is cardioprotective in preclinical studies and is a potential therapeutic target. Cocaine increases sympathetic tone and is a potent proarrhythmogenic agent. It increases the risk of myocardial infarction and can also lead to a dilated cardiomyopathy. The use of beta-blockers in those with HF and cocaine use is likely safe and effective. Future studies are needed to further elucidate the impact of these substances both on the development of HF and their effects on those who have HF.