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Stimulant-Involved Cardiovascular Disease Mortality and Life Years Lost, 2014 to 2023
Rebecca Arden Harris1,2,3, Sameed Ahmed M Khatana2,4,5, Dana A Glei6
1Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Insights
Stimulant-involved cardiovascular disease (CVD) mortality sharply increased from 2014-2023, particularly with methamphetamine and cerebrovascular disease. This trend highlights urgent needs for targeted prevention and intervention strategies.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Toxicology
Background:
- Cocaine and methamphetamine are potent cardiotoxic stimulants.
- These drugs elevate risks for hypertension, coronary artery disease, arrhythmias, cardiomyopathy, and stroke.
Purpose of the Study:
- To analyze trends in stimulant-involved cardiovascular disease (CVD) mortality in the U.S. from 2014 to 2023.
- To examine CVD subtypes, stimulant types, population characteristics, and years of life lost (YLL).
Main Methods:
- Utilized National Vital Statistics System data (2014-2023).
- Analyzed age-adjusted mortality rates (AAMRs) for CVD as the underlying cause with stimulant contribution.
- Employed Joinpoint regression for trend analysis (AAPC) and calculated YLL.
Main Results:
- Stimulant-involved CVD mortality surged by 10.1% annually, contrasting with stable overall CVD mortality (0.2%).
- Methamphetamine-involved deaths rose faster (13.8%) than cocaine-involved deaths (6.5%).
- Cerebrovascular disease showed the steepest increase (15.9%), followed by hypertensive (12.1%) and ischemic heart diseases (7.9%).
- Older adults (≥65 years) saw the highest increase (20.2%); non-Hispanic American Indian/Alaska Native populations had the highest AAPC (18.1%).
- Nearly 1 million years of life lost (YLL) were attributed to stimulant-involved CVD, primarily among middle-aged males and non-Hispanic White individuals.
Conclusions:
- Stimulant-involved CVD mortality has significantly increased, particularly affecting older adults and specific racial/ethnic groups.
- Cerebrovascular disease demonstrated the most substantial rise among CVD subtypes.
- Findings underscore the critical need for targeted prevention, screening, and intervention strategies to mitigate this growing public health crisis.
Background:
Cocaine and methamphetamine, highly cardiotoxic stimulants, are associated with increased risks of hypertension, coronary artery disease, arrhythmias, cardiomyopathy, and stroke.
Objectives:
This study examines trends in stimulant-involved cardiovascular disease (CVD) mortality in the U.S. from 2014 to 2023, analyzing CVD subtypes, stimulant type, population characteristics, and years of life lost (YLL).
Design:
Trend analysis of age-adjusted mortality rates using serial cross-section mortality data from 2014 to 2023.
Methods:
Using National Vital Statistics System data, we analyzed age-adjusted mortality rates (AAMRs) where CVD was the underlying cause of death and stimulants were contributing factors. We used Joinpoint regression to estimate average annual percent change (AAPC) and compare trends across groups. We calculated YLL based on age at death and demographic-specific life expectancies.
Results:
From 2014 to 2023, stimulant-involved CVD mortality rose sharply (AAPC: 10.1%), contrasting with stable rates of overall CVD mortality (AAPC: 0.2%). Methamphetamine-involved deaths increased faster (AAPC: 13.8%) than cocaine-involved deaths (AAPC: 6.5%). Among CVD subtypes, cerebrovascular disease showed the steepest rise (AAPC: 15.9%), followed by hypertensive (12.1%) and ischemic heart diseases (7.9%). Older adults (⩾65 years) exhibited the most pronounced increase in stimulant-involved CVD mortality (AAPC: 20.2%), while non-Hispanic American Indian/Alaska Native populations experienced the highest AAPC among racial/ethnic groups (18.1%). Stimulant-involved CVD caused nearly 1 million years of YLL, predominantly among middle-aged males (687 430 YLL) and non-Hispanic White individuals (511 120 YLL). Methamphetamine involvement (580 570 YLL) exceeded that of cocaine (423 528 YLL). Within CVD types, ischemic heart disease was the leading cause (406 248 YLL).
Conclusions:
Stimulant-involved CVD mortality has surged, especially among non-Hispanic American Indian/Alaska Native and non-Hispanic White populations and older adults, with cerebrovascular disease showing the largest increase among CVD subtypes. The findings reveal the importance of targeted prevention, screening, and intervention.
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