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Substance use disorder linked with increased cardiac mortality

In January 2024, the Journal of the American Heart Association (AHA) published an article by Minhas and Kewcharoen describing substance use (SU) and cardiovascular disease (CVD) mortality from 1999 to 2019. The authors utilised the Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from the US Centers for Disease Control and Prevention (CDC) for their study, analysing death certificates in which both SU and CVD were listed as causes of death. The authors found an overall increase in SU+CVD mortality, and that sex, age, race, and substance type all affect risk.

Minhas and Kewcharoen found that the burden of deaths (measured as age-adjusted mortality rate per 100,000 population, or AAMR) due to CVD outstripped SU deaths, and that SU was only involved in 2.2% of CVD deaths. However, with an average annual per cent change (AAPC) of 4.0%, SU+CVD deaths increased more than either SU deaths or CVD deaths alone. In fact, the rate of CVD deaths decreased from 1999–2019 (AAPC -1.5%), indicating that this trend is being driven by substance use.

The burden of (AAMR) and increase in (AAPC) SU+CVD deaths acted independently when measured by age and sex. While more men than women died of SU+CVD (AAMR 22.5 and 6.8, respectively) over the study period, deaths in women increased more than deaths in men (AAPC 4.8% and 3.6%, respectively). A similar discrepancy is seen by age group. People aged 25–39 experienced the fewest SU+CVD deaths (AAMR 5.3) but also the highest increase (AAPC 5.3%). Those aged 55–69 experienced the most deaths (AAMR 25.1) but only the second-highest increase (AAPC 4.9%). The oldest age group, aged 85 and older, saw both the second-fewest SU+CVD deaths (AAMR 9.4) and the slowest increase (AAPC 0.9%). Intervention is therefore most needed in young people and least in people 85 and older.

Non-Hispanic American Indians and Alaskan Natives suffered the most SU+CVD deaths (AAMR 37.7) and the greatest increase (AAPC 5.4%), putting them at greatest risk of SU+CVD death. The second-highest increase in SU+CVD deaths is seen in non-Hispanic whites (AAPC 5.1%), then non-Hispanic Asians and Pacific Islanders (AAPC 3.5%), and equally in Hispanics and non-Hispanic Blacks (AAPC 1.6%). This suggests there should be a focus on racial populations with increasing risk for SU+CVD death, like non-Hispanic indigenous and white groups.

Substance-type data contrasted the burden of deaths and increase over time. While cannabis is responsible for the fewest deaths (AAMR 0.07), it saw the second-highest increase (AAPC 12.7%). In contrast, alcohol is responsible for the most deaths (AAMR 9.09) but the lowest increase (AAPC 2.7%). Another notable substance is stimulants, which experienced the greatest increase (AAPC 16.8%) and are responsible for a moderate burden of deaths (AAMR 0.95). Focused interventions on stimulants, cannabis, and alcohol may have the greatest impact on SU+CVD deaths.

In 2024, GlobalData epidemiologists predict 2.2 million diagnosed prevalent cases of cardiomyopathy, 6.5 million diagnosed prevalent cases of congestive heart failure, and 18.7 million diagnosed prevalent cases of coronary artery disease, as well as 39.3 million 12-month prevalent cases of alcohol use disorder and one million diagnosed prevalent cases of opioid addiction in the US. Considering the mortality trends here described, GlobalData may predict future SU+CVD mortality using existing prevalence data and inform and measure interventions.

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By GlobalData