TY - JOUR
T1 - Cocaine and Marijuana Use Among Young Adults With Myocardial Infarction
AU - DeFilippis, Ersilia M.
AU - Singh, Avinainder
AU - Divakaran, Sanjay
AU - Gupta, Ankur
AU - Collins, Bradley L.
AU - Biery, David
AU - Qamar, Arman
AU - Fatima, Amber
AU - Ramsis, Mattheus
AU - Pipilas, Daniel
AU - Rajabi, Roxanna
AU - Eng, Monica
AU - Hainer, Jon
AU - Klein, Josh
AU - Januzzi, James L.
AU - Nasir, Khurram
AU - Di Carli, Marcelo F.
AU - Bhatt, Deepak L.
AU - Blankstein, Ron
N1 - Funding Information:
Dr. Gupta is supported by National Institutes of Health grant 5T32HL094301. Dr. Qamar is supported by National Institutes of Health grant T32HL007604. Dr. Januzzi has received grant support from Roche Diagnostics, Abbott, Singulex, and Prevencio; has received consulting income from Roche Diagnostics, Critical Diagnostics, Janssen, and Novartis; and participates in clinical endpoint committees or data safety monitoring boards for Novartis, Amgen, Pfizer, Janssen, AbbVie, and Boehringer-Ingelheim. Dr. Di Carli has received a research grant from Spectrum Dynamics; is on the scientific advisory board of Sanofi; is on the medical advisory board of General Electric Healthcare; and has received consulting honoraria from Sanofi and General Electric Healthcare. Dr. Bhatt is on the advisory boards of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; is on the board of directors of the Boston VA Research Institute and the Society of Cardiovascular Patient Care; is chair of the American Heart Association Quality Oversight Committee; is on the data monitoring committees of the Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, and Population Health Research Institute; has received honoraria from the American College of Cardiology (senior associate editor, Clinical Trials and News, acc.org; vice-chair, American College of Cardiology accreditation committee), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor; associate editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (chief medical editor, Cardiology Today’s Intervention), and the Society of Cardiovascular Patient Care (secretary/treasurer), WebMD (CME steering committees); is deputy editor of Clinical Cardiology; is chair of the NCDR-ACTION Registry Steering Committee and the VA CART Research and Publications Committee; has received research funding from Abbott, Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, and The Medicines Company; has received royalties from Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); is a site co-investigator for Biotronik, Boston Scientific, and St. Jude Medical (now Abbott); is a trustee of the American College of Cardiology; and has conducted unfunded research for FlowCo, Merck, PLx Pharma, and Takeda. Dr. Blankstein has served on the advisory board of Amgen; and has received research support from Amgen, Sanofi, and Gilead Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Joseph Alpert, MD, served as Guest Editor for this paper.
Publisher Copyright:
© 2018 American College of Cardiology Foundation
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/6/5
Y1 - 2018/6/5
N2 - 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.
AB - 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.
KW - cocaine
KW - marijuana
KW - myocardial infarction
KW - substance abuse
KW - young adults
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U2 - 10.1016/j.jacc.2018.02.047
DO - 10.1016/j.jacc.2018.02.047
M3 - Article
C2 - 29535062
AN - SCOPUS:85047116080
VL - 71
SP - 2540
EP - 2551
JO - Journal of the American College of Cardiology.
JF - Journal of the American College of Cardiology.
SN - 0735-1097
IS - 22
ER -