Cocaine and Marijuana Use Among Young Adults With Myocardial Infarction

Ersilia M. DeFilippis, Avinainder Singh, Sanjay Divakaran, Ankur Gupta, Bradley L. Collins, David Biery, Arman Qamar, Amber Fatima, Mattheus Ramsis, Daniel Pipilas, Roxanna Rajabi, Monica Eng, Jon Hainer, Josh Klein, James L. Januzzi, Khurram Nasir, Marcelo F. Di Carli, Deepak L. Bhatt, Ron Blankstein

Research output: Contribution to journalArticle

43 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2540-2551
Number of pages12
JournalJournal of the American College of Cardiology
Volume71
Issue number22
DOIs
StatePublished - Jun 5 2018

Keywords

  • cocaine
  • marijuana
  • myocardial infarction
  • substance abuse
  • young adults

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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