Author + information
- Received February 11, 2018
- Revision received February 26, 2018
- Accepted February 26, 2018
- Published online March 10, 2018.
- Ersilia M. DeFilippis, MDa,
- Avinainder Singh, MBBSa,
- Sanjay Divakaran, MDa,
- Ankur Gupta, MD PhDa,
- Bradley L. Collins, BAa,
- David Biery, BSa,
- Arman Qamar, MDa,
- Amber Fatima, MBBSb,
- Mattheus Ramsis, MDa,
- Daniel Pipilas, MDa,
- Roxanna Rajabi, BSc,
- Monica Eng, BSc,
- Jon Hainer, BSc,
- Josh Klein, BSc,
- James L. Januzzi, MDd,
- Khurram Nasir, MD MPHe,
- Marcelo F. Di Carli, MDa,c,
- Deepak L. Bhatt, MD MPHa and
- Ron Blankstein, MDa,c,∗ ()
- aCardiovascular Division, Department of Medicine., Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- bDepartment of Medicine, Tufts Medical Center, Boston, Massachusetts
- cDepartment of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- dCardiovascular Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- eMiami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida
- ↵∗Correspondence to: Ron Blankstein, MD Brigham & Women’s Hospital 75 Francis Street Boston, MA 02115 Telephone: +1 857 307 1989 Fax: +1 857 307 1955.
Background Substance abuse is increasingly prevalent among young adults but data on cardiovascular outcomes remain limited.
Objectives Our objective was to assess the prevalence of cocaine and marijuana use in adults with their first myocardial infarction (MI) at ≤50 years and determine its association with long-term outcomes.
Methods We retrospectively analyzed records of patients presenting with a Type 1 MI at ≤50 years at two academic hospitals from 2000-2016. Substance abuse was determined by review of records for either patient-reported substance abuse during the week prior to MI or detection on toxicology screen. Vital status was identified by the Social Security Administration’s Death Masterfile. 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 2097 patients had Type 1 MI (mean age 44±5.1 years, 19.3% female, 73% white) with median follow-up of 11.2 years (interquartile range: 7.3-14.2). 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% versus 20.4%, p = 0.05) and hyperlipidemia (45.7% versus 60.8%, p < 0.001), but were significantly more likely to use tobacco (70.3% versus 49.1%, p < 0.001). The use of cocaine and/or marijuana was associated with significantly higher 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) 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 highlight the need for counseling to prevent future adverse events.
Funding: Dr. Gupta is supported by National Institutes of Health grant number 5T32HL094301. Dr. Qamar is supported by National Institutes of Health grant number T32HL007604.
Disclosures: Dr. Januzzi has received grant support from Roche Diagnostics, Abbott, Singulex and Prevencio, consulting income from Roche Diagnostics, Critical Diagnostics, Janssen and Novartis, and participates in clinical endpoint committees/data safety monitoring boards for Novartis, Amgen, Pfizer, Janssen, AbbVie, and Boehringer-Ingelheim. Dr. Bhatt discloses the following relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC 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), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott); Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda. Dr. Blankstein has served on the advisory board of Amgen; and has received research support from Amgen Inc., Sanofi Inc, and Gilead Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
To be presented on March 18 at the American College of Cardiology 2018 Scientific Sessions
- Received February 11, 2018.
- Revision received February 26, 2018.
- Accepted February 26, 2018.
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