Cocaine, Marijuana Use Linked to Worse Myocardial Infarction Mortality Outcomes

Ersilia M. DeFilippis, MD

Adults that use substances generally suffer the worst possible outcomes of a myocardial infarction (MI), according to a recent study.

Researchers from the Brigham and Women’s Hospital in Boston — led by Ersilia M. DeFilippis, MD, internal medicine resident — reported the debilitating effects of cocaine and marijuana use on patients who suffer type 1 MI at the age of 50 years or younger in a retrospective analysis. Their results were initially reported at the 67^th American College of Cardiology’s Annual Scientific Session.

The team researched the records of 2097 patients treated for type 1 MI at one of 2 academic hospitals from 2000-2016. They determined substance abuse through either patient-reported abuse in the week prior to the MI, or detection on toxicology screening. Vital status was identified by the Social Security Administration’s Death Masterfile, and patient cause of death was determined through electronic medical records and death certificates.

Mean patient age was 44 years old, with a majority reported as men (80.7%) and white (73%). The median follow-up for patients was 11.2 years (IR; 7.3-14.2).

Cocaine and/or marijuana use was present in 224 (10.7%) of all observed patients, with marijuana (125; 6%) reporting slightly more in patients than cocaine (99; 4.7%). The use of either substance was associated with a significantly greater cardiovascular (HR 2.22; 95% CI; 1.27 — 3.7; P = 0.005) and all-cause mortality (HR 1.99; 95% CI; 1.35 — 2.97; P = 0.001) in patients to suffer type 1 MI.

Patients to suffer from the cardiovascular event and abuse substances were also significantly more likely to use tobacco (70.3%) than patients who did not abuse substances (49.1%; P < 0.001). However, the former patient group were also significantly less likely to suffer from diabetes (14.7% versus 20.4%; P = 0.05) or hyperlipidemia (45.7% versus 60.8%; P < 0.001).

Researchers noted the rarity of patients reporting significantly greater cardiovascular and all-cause mortality risk for the condition — despite also reporting lower risks for traditional factors. They advised screening for substance abuse in younger patients with MI, in order to stratify risk and provide counseling and education on the proven risks.

Without speaking to the effects of cocaine, Azhar Supariwala, MD, an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell Health, detailed the strain marijuana use has on the cardiovascular system in a column for MD Magazine.

Supariwala noted marijuana has associated with increased heart rate and postural fluctuations in blood pressure, which could be implicated in the development of MI or strokes. Though there’s limited long-term evidence proving its effect on the cardiovascular system, there’s also limited evidence proving otherwise.

“There are no definitive, rigorous scientific studies to guide us about marijuana use because the drug was illegal for many decades,” Supariwala wrote. “All the observational studies have limited credibility due to other confounding factors such as genetic manipulation of marijuana types and strains, quantification of the use, adverse health behaviors—such as increased calorie intake, obesity, tobacco, alcohol, and cocaine use, and association with HIV.”

Until evidence expands, conclusions are unpredictable.

The study, "Cocaine and Marijuana Use among Young Adults Presenting with Myocardial Infarction: The Partners YOUNG-MI Registry," was published online in the Journal of the American College of Cardiology.