Methamphetamine-Associated Pulmonary Arterial Hypertension: Impact, Mechanisms, and a Framework for Management

Area of Science:

• Cardiology
• Pulmonology
• Toxicology

Background:

• Methamphetamine-associated pulmonary arterial hypertension (Meth-PAH) is an understudied Group 1 PAH subtype.
• Its prevalence is increasing globally with the methamphetamine epidemic.
• No standardized diagnostic criteria or treatment guidelines exist for Meth-PAH.

Purpose of the Study:

• To review the epidemiology, pathophysiology, clinical management, and treatment challenges of Meth-PAH.
• To outline a pragmatic approach for managing Meth-PAH.
• To identify key knowledge gaps in Meth-PAH research.

Main Methods:

• Literature review summarizing existing data on Meth-PAH.
• Proposal of a clinical management strategy.
• Identification of areas requiring further research.

Main Results:

• Meth-PAH requires a structured screening for substance use.
• Initiation of oral PAH-specific therapies is recommended regardless of abstinence.
• Therapy escalation should be based on adherence and serial risk assessment.

Conclusions:

• A multidisciplinary approach is essential for managing Meth-PAH and co-occurring methamphetamine use disorder.
• Further research is needed on Meth-PAH pathophysiology, risk stratification, and treatment efficacy in active users.
• Improved outcomes for this high-risk population depend on addressing both the condition and the substance use disorder.