Rising Cardiovascular Deaths Linked to Substance Use
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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.
Highlighting Inequities
Certain demographics also experienced particularly large increases in cardiovascular deaths linked to substance use.
People who used cannabis and those who used psychostimulants — a broad class of drugs that includes cocaine and methamphetamine as well as prescription medications such as Adderall — experienced higher increases in cardiovascular deaths linked to substance use, though these deaths were not necessarily caused by recent cannabis or psychostimulant use. These deaths among cannabis users increased by nearly 13 percent, while the deaths among people who used psychostimulants increased by nearly 17 percent.
Adults ages 25 to 59 years old and American Indian or Alaska Native (AI-AN) adults also experienced notably large increases, with these deaths going up by about 5.5 percent every year in both groups. People who lived in rural areas saw a 5 percent year-over-year increase in cardiovascular deaths related to substance use. Although men had more deaths overall, women saw a greater increase, at about 5 percent every year.
Understanding which groups are high-risk for these types of deaths is the first step in being able to design interventions, says Abramov.
Addressing the Root Problems
People who identified as AI-AN saw the largest increases, with an average year-over-year increase of 5.4 percent, compared with 5.1 percent for white Americans, 3.8 for Asian and Pacific Islanders, and 1.6 percent for Black and Hispanic Americans.
A combination of factors rooted in systemic racism have caused higher rates of substance use disorder (SUD) among AI-AN communities, says Claradina Soto, PhD, who is Navajo–Jemez Pueblo and an associate professor of clinical population and public health sciences at the University of Southern California Keck School of Medicine’s Institute for Health Promotion and Disease Prevention Research in Los Angeles.
“One is historical trauma that our AI-AN communities have experienced,” she says. “The forced removal from ancestral lands and not allowing us to practice our cultural or traditional ways has really contributed to a range of disparities and one of these is substance use.”
This has led to circumstances that are out of an individual’s control, including living in poverty, limited access to education and healthcare, all which disproportionately high rates of unemployment and inadequate housing all play a role in higher rates of substance use among AI-AN people, Dr. Soto says.
Taking a multidisciplinary approach to this issue is going to be what pulls people out of substance use disorder and subsequently the cardiovascular ramifications of that, notes Bhamidipati.
For starters, any initiatives that address substance use among AI-AN communities should be developed by people within the diverse communities themselves, Soto says.
“It has to engage the community in order for change to occur on that level. There is a complex interplay of social, economic, historical, cultural that we have to consider as we strategize ways to meet the needs of these communities,” she says.
According to Bhatia, previous studies have also shown a rise in substance use among younger people, but it’s still unclear what is driving it. It’s also unclear why women saw a larger increase in substance-use-related cardiovascular deaths compared to men.
“It’s not occasional alcohol or stimulant use that is being reported here, it’s situations where this is much more serious,” Abramov says. “Socioeconomic disparities, an inability to access community resources and healthcare, and mental health all very much contribute to substance abuse.”
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