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Heart Disease and Drugs

Heart disease, including coronary artery disease, heart attack, congestive heart failure and congenital heart disease, is the leading cause of death for men and women in the United States. CDC statistics show that approximately 600,000 people die of heart disease each year, which accounts for one in four deaths nationwide. Coronary heart disease alone costs the United States$108.9 billion each year. This total includes the cost of healthcare services, medications and lost productivity.

While smoking, high cholesterol, high blood pressure, obesity and lack of exercise are well-known contributing factors to the occurrence of heart disease, drug abuse—including excessive alcohol consumption—has been linked to coronary arterial disease. It is estimated that one in four people in developed countries have engaged in recreational drug use at some time in their lives. Therefore, it is inevitable that physicians can expect to manage and treat the complications that arise from recreational drug abuse.

Ethanol (alcohol). Although some studies have suggested that a small amount of alcohol has cardiac benefits, excess alcohol is linked to a greater risk of high blood pressure, high levels of blood fats and heart failure. In addition, the increased caloric intake can lead to weight gain, which itself is a threat to heart health.

Cocaine, amphetamine and ecstasy. All three of these drug types cause similar adverse effects on the cardiovascular system, related predominantly to activation of the sympathetic nervous system. This part of the involuntary (autonomic) nervous system serves to accelerate heart rate, constrict blood vessels and raise blood pressure. Sympathetic stimulation can lead to a variety of clinical effects, including hypertension, myocardial ischemia and infarction (even in patients without myocardial disease), aortic dissection, valvular damage, pulmonary edema, hypertension and serious arrhythmias. Many deaths have been attributed to the use of amphetamine and cocaine.

Narcotic analgesics. Narcotic agents, including morphine and heroin, act centrally on areas of the brain that take part in controlling the diameter of blood vessels, which, in turn, affects blood pressure. Autonomic changes can result in slowed heart rate (bradycardia) and hypotension. Certain cardiac arrhythmias, including atrial fibrillation and ventricular tachycardia, have been reported. Bacterial endocarditis (inflammation of the lining of the heart) is a well-known complication of intravenous drug use. Additionally, heroin overdose can cause pulmonary edema, which can be delayed for up to 24 hours after use.

Cannabis. In patients with ischemic heart disease, cannabis may increase the frequency of symptoms related to angina due to drug-induced increases in heart rate, which elevates oxygen demand. Although abnormal ectopic cardiac activity has been seen following the use of marijuana, life-threatening cardiac events have not been recorded.

Since 1963, February has been celebrated as American Heart Month to urge Americans to make lifestyle changes that will ensure heart health for a lifetime. Cordant Health Solutions encourages everyone to learn the risks for heart disease and understand what can be done to stay heart-healthy for yourself and your loved-ones.

 

 

References:

-Murphy SL, Xu JQ, Kochanek KD. Deaths: Final Data for 2010. Natl Vital Stat Rep. 2013;61(4).https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf.

-Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the Future of Cardiovascular Disease in the United States: A Policy Statement from the American Heart Association. Circulation. 2011;123:933–944. Epub 2011 Jan 24.

-Ghuran A, Nolan J. Recreational Drug Misuse: Issues for the Cardiologist. Heart 2000; 83:627–633.

-Ghuran A, Nolan J. The Cardiac Complications of Recreational Drug Use. Western Journal of Medicine 2000; 173 (6): 412–415.

-CDC. Million Hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors. United States, 2011.MMWR2011;60(36):1248–51.