Substance Use Increases Risks for Heart Attacks, Study Reports

By Kaitlin Sullivan Medically Reviewed by Anurag Sahu, MD on 2/62024

Despite sharp declines in deaths from coronary heart disease and heart attacks over the past two decades, the rate of cardiovascular deaths linked to substance use rose by an average of 4 percent every year between 1999 and 2019, recent research suggests.

The rate of these deaths increased in all age and racial groups, but certain communities experienced starker year-over-year spikes.

“It is very concerning that despite overall improvements in cardiovascular mortality, rates of death related to substance use are increasing,” says Harpreet Bhatia, MD, assistant clinical professor of medicine in the University of California in San Diego division of cardiovascular medicine, who was not involved in the study. “It is particularly concerning that these trends appear to be worsening existing health disparities, and to be having a significant impact on young adults.”

Stimulant Use on the Rise

Substance use of any kind — whether that be alcohol, cocaine, marijuana, or crystal meth — puts a strain on the cardiovascular system. It can weaken the heart muscle, cause abnormal heart rhythms, and accelerate cholesterol buildup in the arteries, Dr. Bhatia says.

The new study, published in January 2024, in the Journal of the American Heart Association, included data from the Centers for Disease Control and Prevention’s (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database.

Study authors identified nearly 29.5 million deaths related to cardiovascular disease in people who were at least 25 years old. Medical certificate of death records indicated that substance use played a role in about 637,000 of the deaths. Ischemic heart disease in addition to substance use was the most common cause of death, followed by heart failure, stroke, and a tear in the lining of the artery, called an aortic dissection.

The researchers looked into which substances were most frequently involved, as well as which racial and ethnic groups, biological sexes, age groups, and geographical demographics were at highest risk.

They found that most of these deaths — 65 percent — were related to alcohol, but that number did not paint a clear picture of how substance use–related cardiovascular deaths are changing.

“We need to look at what is becoming increasingly common,” says Dmitry Abramov, MD, a cardiologist and associate professor of medicine at Loma Linda University Health in California, who led the study. “The increase in cardiovascular deaths related to stimulants, largely being methamphetamine, saw a more prominent increase, as did opioids.”

Dr. Abramov also noted that heavy alcohol use, not having an occasional drink, was behind the deaths.

Stimulant-related cardiovascular deaths rose by more than 18 percent year-over-year, compared with about 2.5 percent for alcohol. Deaths that involved opioids rose about 8 percent every year.

“Stimulants such as methamphetamine are an increasingly concerning cause of cardiovascular disease. This has long been a recognized problem on the West Coast, but has been increasing nationally in recent years,” Bhatia says.

A study published in the journal JAMA Psychiatry used National Institutes of Health data on drug use to determine that methamphetamine use increased by 43 percent between 2015 and 2019. People who had methamphetamine use disorder increased by 62 percent, and methamphetamine use quadrupled among people ages 18 to 23 who did not inject the drug.

According to a?study published in Nature Communications Biology, methamphetamine-associated cardiomyopathy, a condition in which methamphetamine use causes severe changes to the heart muscle that result in heart failure, is the leading cause of death linked with illicit drug use. A recent study published in the journal Addiction, found that the percent of overdose deaths in the United States that involved both fentanyl — a potent opioid — and stimulants increased from 0.6 percent in 2010 to more than 32 percent in 2021.

There is a direct link between methamphetamine and the cardiovascular system, says Castigliano Bhamidipati, MD, quality medical director for the Knight Cardiovascular Institute at Oregon Health and Science University in Portland.

“Methamphetamine significantly increases load on the body, and after a certain amount of exposure, the heart muscle isn’t able to pump,” Dr. Bhamidipati says.

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