The prevalence of methamphetamine use in patients presenting with acute coronary syndrome (ACS) was close to 15% in one Northern California medical center, and the drug resulted in significantly reduced survival, according to a new study. 

The findings, published in the Journal of the American Heart Association, are important despite being limited to one center because the drug is not well understood in the ACS setting, and methamphetamine-associated ACS is believed to occur more often than is reported, researchers said. 

In fact, the use of methamphetamines has been increasing nationwide and may be approaching the levels of an epidemic, according to another study. To put it simply: Methamphetamine is no longer just a street drug, said Susan Zhao, MD, researcher of the present study.

“That’s why we undertook this project, to systematically characterize this group of patients who suffered heart attack in the setting of meth use,” said Zhao, who is medical director of the coronary care unit at Santa Clara Valley Medical Center in San Jose, California, and a clinical associate professor of medicine (affiliated) at Stanford University School of Medicine. 

“We hypothesized that they were distinctly different from the traditional myocardial infarction population,” she added. 

Young Users and Death Rates 

The research showed methamphetamine users were more often male and younger than nonusers and lacked traditional risk factors for heart disease.

“Despite their younger age, these patients experienced worse overall death rates and higher recurrent cardiac events,” Zhao said in an interview. 

For the retrospective study of cases at Santa Clara Valley HealthCare, researchers enrolled patients aged 18-65 years who presented with ACS and underwent coronary angiography from 2012 to 2022. Exclusion criteria included cocaine use and those who had other non-type 1 myocardial infarction.

An Important Safety Signal 

From 1309 cases, researchers reported 194 patients with methamphetamine-associated ACS, resulting in a prevalence of 14.8%. However, Zhao noted that the actual prevalence could be higher because they only included patients who underwent angiography. And many cases were never referred due to various reasons, such as low awareness of the association and competing diagnostic priorities, she said. 

Results indicated methamphetamine use was associated with younger age (52 years vs 57 years) and nonobstructive coronary diseases (24.2% vs 10.6%; P for both < .001). Methamphetamine users were also more likely to be smokers, users of alcohol, homeless (P for all < .001), and male (P = .022). Patients with methamphetamine-associated ACS demonstrated significantly reduced survival (P = .005), a finding that remained after adjustment for confounders.

Among independent predictors for all-cause mortality, methamphetamine use was the strongest in multivariable analysis (adjusted hazard ratio, 2.08; 95% CI, 1.40-3.09; P < .001).

Robert L. Page II, PharmD, MSPH, a professor of clinical pharmacy, medicine, and physical medicine at the University of Colorado Anschutz Skaggs School of Pharmacy and Pharmaceutical Sciences in Aurora, said that while the findings are retrospective and observational, the safety signal generated is fairly strong and should not be ignored.

“In my mind, these data suggest that methamphetamine is not an innocent bystander but a direct actor in mediating the development of major cardiac events and should be considered a possible independent risk factor for a heart attack,” said Page, who was not involved in the study. “However, I do want to highlight that the data may be clouded by the fact that 71% in the methamphetamine cohort were also cigarette smokers, and cigarette smoking is a definite risk factor for a heart attack.”

More Than Just a Street Drug 

When patients present to the emergency department with signs and symptoms of a myocardial infarction, particularly when they are young adults, they should undergo a urine drug screen, Page said. This screening is not typical, but it would allow methamphetamine use to be a part of the deferential diagnosis in order to implement early inpatient and future outpatient interventions, he said.

Methamphetamine has evolved from a street drug used by hardened addicts into something more casual, favored by functional members in the community, even as a performance-enhancing drug for certain occupations, Zhao said. 

“That’s why raising awareness about these severe downstream cardiac complications from long-term use is so critically important,” she said.

Zhao and Page reported no relevant financial relationships. 

Brian Ellis is a freelance writer and editor who lives in Southwest Virginia.