Ersilia M DeFilippis1, Avinainder Singh1, Sanjay Divakaran1, Ankur Gupta1, Bradley L Collins1, David Biery1, Arman Qamar1, Amber Fatima2, Mattheus Ramsis1, Daniel Pipilas1, Roxanna Rajabi3, Monica Eng3, Jon Hainer3, Josh Klein3, James L Januzzi4, Khurram Nasir5, Marcelo F Di Carli6, Deepak L Bhatt1, Ron Blankstein7. 1. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 2. Department of Medicine, Tufts Medical Center, Boston, Massachusetts. 3. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 4. Cardiovascular Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. 5. Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida. 6. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 7. Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: rblankstein@bwh.harvard.edu.
Abstract
BACKGROUND: Substance abuse is increasingly prevalent among young adults, but data on cardiovascular outcomes remain limited. OBJECTIVES: The objectives of this study were to assess the prevalence of cocaine and marijuana use in adults with their first myocardial infarction (MI) at ≤50 years and to determine its association with long-term outcomes. METHODS: The study retrospectively analyzed records of patients presenting with a type 1 MI at ≤50 years at 2 academic hospitals from 2000 to 2016. Substance abuse was determined by review of records for either patient-reported substance abuse during the week before MI or substance detection on toxicology screen. Vital status was identified by the Social Security Administration's Death Master File. Cause of death was adjudicated using electronic health records and death certificates. Cox modeling was performed for survival free from all-cause and cardiovascular death. RESULTS: A total of 2,097 patients had type 1 MI (mean age 44.0 ± 5.1 years, 19.3% female, 73% white), with median follow-up of 11.2 years (interquartile range: 7.3 to 14.2 years). Use of cocaine and/or marijuana was present in 224 (10.7%) patients; cocaine in 99 (4.7%) patients, and marijuana in 125 (6.0%). Individuals with substance use had significantly lower rates of diabetes (14.7% vs. 20.4%; p = 0.05) and hyperlipidemia (45.7% vs. 60.8%; p < 0.001), but they were significantly more likely to use tobacco (70.3% vs. 49.1%; p < 0.001). The use of cocaine and/or marijuana was associated with significantly higher cardiovascular mortality (hazard ratio: 2.22; 95% confidence interval: 1.27 to 3.70; p = 0.005) and all-cause mortality (hazard ratio: 1.99; 95% confidence interval: 1.35 to 2.97; p = 0.001) after adjusting for baseline covariates. CONCLUSIONS: Cocaine and/or marijuana use is present in 10% of patients with an MI at age ≤50 years and is associated with worse all-cause and cardiovascular mortality. These findings reinforce current recommendations for substance use screening among young adults with an MI, and they highlight the need for counseling to prevent future adverse events.
BACKGROUND:Substance abuse is increasingly prevalent among young adults, but data on cardiovascular outcomes remain limited. OBJECTIVES: The objectives of this study were to assess the prevalence of cocaine and marijuana use in adults with their first myocardial infarction (MI) at ≤50 years and to determine its association with long-term outcomes. METHODS: The study retrospectively analyzed records of patients presenting with a type 1 MI at ≤50 years at 2 academic hospitals from 2000 to 2016. Substance abuse was determined by review of records for either patient-reported substance abuse during the week before MI or substance detection on toxicology screen. Vital status was identified by the Social Security Administration's Death Master File. Cause of death was adjudicated using electronic health records and death certificates. Cox modeling was performed for survival free from all-cause and cardiovascular death. RESULTS: A total of 2,097 patients had type 1 MI (mean age 44.0 ± 5.1 years, 19.3% female, 73% white), with median follow-up of 11.2 years (interquartile range: 7.3 to 14.2 years). Use of cocaine and/or marijuana was present in 224 (10.7%) patients; cocaine in 99 (4.7%) patients, and marijuana in 125 (6.0%). Individuals with substance use had significantly lower rates of diabetes (14.7% vs. 20.4%; p = 0.05) and hyperlipidemia (45.7% vs. 60.8%; p < 0.001), but they were significantly more likely to use tobacco (70.3% vs. 49.1%; p < 0.001). The use of cocaine and/or marijuana was associated with significantly higher cardiovascular mortality (hazard ratio: 2.22; 95% confidence interval: 1.27 to 3.70; p = 0.005) and all-cause mortality (hazard ratio: 1.99; 95% confidence interval: 1.35 to 2.97; p = 0.001) after adjusting for baseline covariates. CONCLUSIONS:Cocaine and/or marijuana use is present in 10% of patients with an MI at age ≤50 years and is associated with worse all-cause and cardiovascular mortality. These findings reinforce current recommendations for substance use screening among young adults with an MI, and they highlight the need for counseling to prevent future adverse events.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Ezra A Amsterdam; Nanette K Wenger; Ralph G Brindis; Donald E Casey; Theodore G Ganiats; David R Holmes; Allan S Jaffe; Hani Jneid; Rosemary F Kelly; Michael C Kontos; Glenn N Levine; Philip R Liebson; Debabrata Mukherjee; Eric D Peterson; Marc S Sabatine; Richard W Smalling; Susan J Zieman Journal: J Am Coll Cardiol Date: 2014-09-23 Impact factor: 24.094
Authors: Navdeep Gupta; Jeffrey B Washam; Stavros E Mountantonakis; Shuang Li; Matthew T Roe; James A de Lemos; Rohit Arora Journal: Am J Cardiol Date: 2013-12-12 Impact factor: 2.778
Authors: D J Moliterno; J E Willard; R A Lange; B H Negus; J D Boehrer; D B Glamann; C Landau; J D Rossen; M D Winniford; L D Hillis Journal: N Engl J Med Date: 1994-02-17 Impact factor: 91.245
Authors: Wanda Y Wu; David W Biery; Avinainder Singh; Sanjay Divakaran; Adam N Berman; Gloria Ayuba; Ersilia M DeFilippis; Khurram Nasir; James L Januzzi; Marcelo F Di Carli; Deepak L Bhatt; Ron Blankstein Journal: J Am Coll Cardiol Date: 2020-06-09 Impact factor: 24.094
Authors: Ryhm Radjef; Edward L Peterson; Alexander Michaels; Bin Liu; Hongsheng Gui; Hani N Sabbah; John A Spertus; L Keoki Williams; David E Lanfear Journal: Circ Cardiovasc Qual Outcomes Date: 2019-07-03
Authors: Ersilia M DeFilippis; Navkaranbir S Bajaj; Amitoj Singh; Rhynn Malloy; Michael M Givertz; Ron Blankstein; Deepak L Bhatt; Muthiah Vaduganathan Journal: J Am Coll Cardiol Date: 2020-01-28 Impact factor: 24.094
Authors: Junjie Yang; David W Biery; Avinainder Singh; Sanjay Divakaran; Ersilia M DeFilippis; Wanda Y Wu; Josh Klein; Jon Hainer; Mattheus Ramsis; Pradeep Natarajan; James L Januzzi; Khurram Nasir; Deepak L Bhatt; Marcelo F Di Carli; Ron Blankstein Journal: Am J Med Date: 2019-11-09 Impact factor: 4.965
Authors: Sagar B Dugani; Matteo Fabbri; Alanna M Chamberlain; Suzette J Bielinski; Susan A Weston; Sheila M Manemann; Ruoxiang Jiang; Véronique L Roger Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-04-16