People with premature and extremely premature atherosclerotic cardiovascular diseases (ASCVDs) tend to use recreational substances at a higher rate than do patients with nonpremature ASCVD, a study in Heart suggests.
The study included 135,703 patients with premature ASCVD, 7716 with extremely premature ASCVD, and 1,112,455 patients with nonpremature ASCVD from the 2014 to 2015 nationwide Veterans Affairs Healthcare database and the Veterans With Premature Atherosclerosis (VITAL) registry.
The investigators defined premature ASCVD as having a first ASCVD event at the age of < 55 years for men and < 65 years for women, whereas the extremely premature classification was given to patients who had a first ASCVD event at age < 40 years. In contrast, patients were classified as having nonpremature ASCVD if they had a first ASCVD event at age ≥ 55 years for men and ≥ 65 years for women.
A greater proportion of patients with premature ASCVD had higher use of tobacco (62.9% vs 40.6%; P <.01), alcohol (31.8% vs 14.8%; P <.01), cocaine (12.9% vs 2.5%; P <.01), amphetamine (2.9% vs 0.5%; P <.01), and cannabis (12.5% vs 2.7%; P <.01) compared with patients with nonpremature ASCVD. Patients with extremely premature ASCVD had the highest frequency of use for all illicit drugs.
In the adjusted analysis, independent factors associated with premature ASCVD included the use of tobacco (odds ratio [OR], 1.97; 95% CI, 1.94-2.00; P <.01), alcohol (OR, 1.50; 95% CI, 1.47-1.52; P <.01), cocaine (OR, 2.44; 95% CI, 2.38-2.50; P <.01), amphetamine (OR, 2.74; 95% CI, 2.62-2.87; P <.01), cannabis (OR, 2.65; 95% CI, 2.59-2.71; P <.01), and other drugs (OR, 2.53; 95% CI, 2.47-2.59; P <.01).
In regard to polysubstance use, the likelihood of premature ASCVD rose in a graded response with increasing number of used recreational substances, including only 1 substance (OR, 2.05; 95% CI, 2.02-2.08; P <.01), only 2 substances (OR, 3.45, 95% CI, 3.38-3.52; P <.01), only 3 substances (OR, 6.38; 95% CI, 6.18-6.58; P <.01), and ≥ 4 substances (OR, 8.85; 95% CI, 8.63-9.08; P <.01).
Limitations of this cross-sectional analysis study was its observational design and the lack of assessment regarding how well patients’ comorbidities or medical therapy adherence were controlled.
The investigators suggest that the “recognition of these strong associations would allow clinicians to be aggressive about providing young patients with drug cessation resources.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Mahtta D, Ramsey D, Krittanawong C, et al. Recreational substance use among patients wih premature atherosclerotic cardiovascular disease. Heart.Published online February 15, 2021. doi:10.1136/heartjnl-2020-318119