Methamphetamine-Associated Pulmonary Arterial Hypertension and Dilated Cardiomyopathy

Study Questions:

Are there factors correlated with methamphetamine-associated pulmonary arterial hypertension (MA-PAH) and cardiomyopathy (MA-CMP), not seen in MA user controls (MA-CTL) with structurally normal hearts?

Methods:

The authors retrospectively studied the clinical characteristics and outcomes of 50 MA-PAH, 296 MA-CMP, and 356 MA-CTL patients evaluated between 2010 and 2017.

Results:

After a median follow-up of 20.0 months (interquartile range [IQR], 7.6-42.6 months), all-cause mortality was 18.0% for MA-PAH, 15.2% for MA-CMP, and 4.5% for the MA-CTL group (p < 0.001). More women (58%) were in the MA-PAH group than in the MA-CMP (14%; p < 0.001) and MA-CTL (42%; p = 0.028) groups, whereas the MA-CMP group was predominantly male (86% vs. 58% in the MA-CTL group; p < 0.001). More MA-CMP patients had hypertension (p < 0.001) or alcoholism (p < 0.001) than MA-CTL patients. Logistic regression analyses identified male sex, alcoholism, and hypertension as independent factors associated with MA-CMP with the following respective adjusted odds ratios (ORs) of 3.79 (95% confidence interval [CI], 2.50-5.73), 2.96 (95% CI, 2.08-4.20), and 2.11 (95% CI, 1.49-3.0), whereas female sex was the only factor associated with MA-PAH.

Conclusions:

Both MA-PAH and MA-CMP patients carried significant disease burden and mortality risk. Male sex, hypertension, and alcoholism were strongly associated with MA-CMP, whereas female sex and other unknown factors may influence development of MA-PAH.

Perspective:

Drug-induced PAH is a World Health Organization Group 1 PH characterized by severe small-vessel loss and obstructive vasculopathy, leading to progressive right heart failure and death. The first drug group identified was the appetite suppressants, which in the US was fenfluramine and dexfenfluramine. Since only a small percent exposed get PAH, it is likely that genetic susceptibility plays a role in pathogenesis, and similarly for methamphetamine (MA). This is the largest and most comprehensive study of the impact of MA use on PAH and cardiomyopathy. Because of the retrospective design, the prevalence of PAH and CM cannot be assessed. Nevertheless, the important message is to always assess for use of ‘meth’ and other sympathomimetic drugs and cocaine in patients with PAH and CM, and consider a screening blood level and echo-Doppler in illicit drug users.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Acute Heart Failure, Pulmonary Hypertension, Hypertension

Keywords: Alcoholism, Cardiomyopathies, Cardiomyopathy, Dilated, Genetic Predisposition to Disease, Heart Failure, Hypertension, Hypertension, Pulmonary, Methamphetamine, Secondary Prevention, Street Drugs


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