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Associations Between Sustained Methamphetamine/Amphetamine Use and Left Ventricular Dysfunction in a Cohort of Women
Elise D Riley1, Yifei Ma1, Katherine C Wu2
1University of California San Francisco CA USA.
Insights
Sustained methamphetamine/amphetamine use significantly increases the risk of diastolic dysfunction in women, regardless of HIV status. This highlights the need for routine substance use screening in cardiovascular risk assessments for vulnerable women.
Area of Science:
- Cardiology
- Public Health
- Infectious Diseases
Background:
- Substance use is linked to heart disease, with women with HIV showing high rates of substance use.
- The relationship between polysubstance use and specific cardiovascular conditions in women with HIV remains understudied.
Purpose of the Study:
- To investigate the association between sustained substance use and left ventricular dysfunction in women with and without HIV.
- To identify specific substances contributing to cardiac conditions in this population.
Main Methods:
- Echocardiography was used to measure left ventricular systolic dysfunction (LVSD) and diastolic dysfunction (LVDD) in 1651 participants from the Women's Interagency HIV Study (WIHS).
- Sustained use of substances (stimulants, opioids, tobacco, alcohol, sedatives) was defined as use reported at ≥2 visits.
- LVSD and LVDD were assessed as precursors to heart failure.
Main Results:
- No significant association was found between sustained substance use and LVSD.
- Sustained methamphetamine/amphetamine use was strongly associated with LVDD (OR 6.82), independent of other substance use.
- Among women with HIV, methamphetamine/amphetamine use (OR 5.31) and cigarette use (OR 1.87) were associated with LVDD.
Conclusions:
- Sustained methamphetamine/amphetamine use is a significant independent risk factor for LVDD in women, irrespective of HIV status.
- Routine screening for methamphetamine/amphetamine use can enhance heart failure risk assessment in vulnerable women.
Background:
Substance use is associated with cardiac disease, and women with HIV have a disproportionately high prevalence of substance use. However, the extent to which ongoing use of multiple substances relates to specific cardiovascular conditions in women with HIV and sociodemographically similar women without HIV ("at risk for HIV") remains understudied.
Methods:
We measured left ventricular systolic dysfunction (LVSD) and diastolic dysfunction (LVDD), conditions that precede clinical heart failure, among 1651 participants of the multisite WIHS (Women's Interagency HIV Study). Using standardized echocardiography, we determined associations between the use of substances (stimulants, opioids, tobacco, alcohol, sedatives) reported at ≥2 biannual visits ("sustained use") and left ventricular dysfunction. LVSD was defined as left ventricular ejection fraction <54%, and LVDD was considered in the absence of LVSD.
Results:
Most participants (75%) identified as non-Hispanic Black, the average age was 49 years, 70% had HIV, and 4.9% had LVSD. In adjusted analysis, none of the sustained substance use categories were significantly associated with LVSD. Among women without LVSD, 6.6% had LVDD. The adjusted odds of LVDD were 6.82 times higher (95% CI, 5.47-8.50) among women with sustained methamphetamine/amphetamine use. Among women with HIV only, the adjusted odds for methamphetamine/amphetamine were 5.31 (95% CI, 4.21-6.70), and adjusted odds for cigarette use were 1.87 (95% CI, 1.39-2.52).
Conclusions:
In this national sample of women with and without HIV, sustained methamphetamine/amphetamine use had an especially strong association with LVDD that was independent of cigarette use. Routine assessment of methamphetamine/amphetamine use in vulnerable women may improve heart failure risk assessment.
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