Illicit stimulants and ventricular arrhythmias: a longitudinal cohort study
Jean Jacques Noubiap1, Thomas A Dewland1, Gabrielle C Montenegro1
1Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
Insights
Illicit stimulant use, including methamphetamine and cocaine, significantly increases the risk of ventricular arrhythmias (VA) and mortality. Avoiding these substances may reduce the risk of sudden cardiac death.
Area of Science:
- Cardiology
- Public Health
- Toxicology
Background:
- Sudden cardiac death is often caused by ventricular arrhythmias (VA).
- Lifestyle factors influencing VA occurrence are not well understood.
- Illicit stimulant use is a potential, understudied risk factor.
Purpose of the Study:
- To investigate the association between methamphetamine and cocaine use and the risk of VA and mortality.
- To identify demographic differences in the risk of VA associated with stimulant use.
Main Methods:
- Retrospective analysis of healthcare databases (2005-2019) in California.
- Inclusion of adults aged 18+ with hospital-based care.
- Cox proportional hazard models adjusting for confounders to assess VA and all-cause mortality.
Main Results:
- Methamphetamine use was associated with a 1.90 HR for VA and 1.51 HR for mortality.
- Cocaine use was associated with a 1.15 HR for VA and 1.68 HR for mortality.
- Increased risk for VA was observed in younger individuals and females; demographic variations existed for race/ethnicity.
Conclusions:
- Both methamphetamine and cocaine use are linked to increased risks of VA and mortality.
- Demographic factors modify the association between stimulant use and adverse cardiovascular outcomes.
- Reducing illicit stimulant use may lower the incidence of VA and associated mortality.
Background And Aims:
Ventricular tachycardia and ventricular fibrillation underlie many sudden cardiac deaths, but common lifestyle factors that predict their occurrence are poorly understood. This study aimed to assess the association between methamphetamine and cocaine, the most used illicit stimulants, and ventricular arrhythmias (VA) and mortality.
Methods:
Healthcare databases were used to identify adults aged ≥ 18 years receiving hospital-based care in California in 2005-2019. ICD codes were used to identify diagnoses and illicit stimulant use. Cox proportional hazard models adjusting for demographics and time-updated cardiovascular risk factors were employed. The outcomes were VA combining ventricular tachycardia, ventricular fibrillation, and cardiac arrest and all-cause mortality.
Results:
Among 29 593 819 individuals (53.8% female, mean age 44.9 years), 690 737 (2.3%) used methamphetamine, and 290 652 (1.0%) used cocaine at some point. After adjustment for age, sex, race and ethnicity, cannabis and opioid use, and other cardiovascular risk factors, methamphetamine use and cocaine use were each associated with increased risk of incident VA [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.85-1.95, and HR 1.15, 95% CI 1.10-1.19, respectively], and mortality (HR 1.51, 95% CI 1.47-1.54 and HR 1.68, 95% CI 1.64-1.72, respectively). The risk of VA was higher in younger individuals (<65 years) and females for both methamphetamine and cocaine, whereas it was higher in Blacks and lower in Whites and Hispanics for cocaine use, and higher in Asians and lower in Blacks for methamphetamine use (P for interaction < .05 in all).
Conclusions:
Methamphetamine use and cocaine use were each associated with increased risk of incident VA and mortality, with differential relationships by demographic groups. Avoiding these substances may reduce risk of VA and death.
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