In a finding that demonstrates methamphetamine's power to destroy the human heart, new research shows hospitalizations for heart failure related to the illicit drug have soared by 585% in California.
"Our study results should bring urgent attention to this insidious, yet rapidly growing, form of severe heart failure -- methamphetamine-related heart failure [MethHF], which is taking the lives of young people, straining health care resources and threatening to spread like wildfire in California, the West and to the rest of the nation," said study author Dr. Susan Zhao. She is a cardiologist at the Santa Clara Valley Medical Center in San Jose, Calif.
Heart failure occurs when your heart becomes too weak to properly pump blood. Symptoms may include fatigue, breathlessness and heart palpitations.
Made infamous in the TV series "Breaking Bad" starring Bryan Cranston as a chemistry-teacher-turned-meth-cook, methamphetamine (or meth for short) is a highly addictive man-made stimulant that can be smoked, snorted, injected or taken orally.
Chronic use of methamphetamine may cause heart failure through persistent activation of the sympathetic nervous systems, leading to increased blood pressure, heart rate, a narrowing and hardening of heart arteries plus other as-yet-unidentified mechanisms, Zhao said.
For the study, the researchers analyzed data on more than one million people in a statewide database who were hospitalized with heart failure from 2008 to 2018. While hospitalizations for methamphetamine-related heart failure rose nearly 600%, those unrelated to methamphetamine use fell by 6%, the study showed.
These aren't your typical heart failure patients either, Zhao said. Most of the people who develop heart failure from meth use are younger than 65, with more than half being between the ages of 35 and 54. They were more likely to be homeless as well. Heart failure typically strikes adults older than 60.
As California goes, so goes the nation
People with meth-related heart failure are also sicker and more likely to have high blood pressure, consume alcohol, and use tobacco and other illicit drugs. These folks stayed in the hospital for longer periods than other heart failure patients and had more procedures performed, resulting in higher health costs. Hospitalization costs for methamphetamine-related heart failure in California rose 840%, from $41.5 million in 2008 to $390.2 million in 2018, the study found.
While the study only looked at data from California, MethHF is likely rising elsewhere, too. "Up and down the West Coast, in particular, is rampant with meth, so MethHF is problematic on the West Coast with a trend towards proliferating eastwards," Zhao said.
The meth problem has been made drastically worse in recent years due to the increase in purer, more potent methamphetamine, she added. There is a five- to 10-year lag between meth use and the development of heart failure. "Even if we stem any new meth users as of today, the cumulative cases from previous years will take years to wane," Zhao explained.
Unfortunately, few are aware of this dangerous link, she said: "Not even frontline clinicians have a clear sense of the scope and urgency of the problem."
To put the brakes on this epidemic, public awareness campaigns, policies to curb meth proliferation, and guidelines designed to care for these patients are needed, Zhao said.
The study was published July 14 in Circulation: Cardiovascular Quality and Outcomes.
In an editorial accompanying the new study, cardiologists Drs. Uri Elkayam and Pavan Reddy noted that the opioid crisis often commands more headlines because of the high risk of immediate overdose deaths.
Did pandemic make things worse?
But, Elkayam and Reddy warned, meth use is "equally dangerous and costly to society but more insidious in nature, its effects potentially causing decades of mental and physical debilitation before ending in premature death."
Dr. Aeshita Dwivedi, a cardiologist at Lenox Hill Hospital in New York City, agreed. "The new study provides a much more detailed and greater light on this issue of drug abuse as a risk factor for heart failure," said Dwivedi, who has no ties to the new study. The onus is on doctors to consider meth use in younger people showing signs of heart failure, she added.
Addiction specialists not involved with the new research are increasingly concerned about the long-term consequences of meth use.
Dr. Joseph Garbely has seen such cases, but not to the scale that they are occurring in California ... yet. He is the chief medical officer and executive vice president of medical research and education at Caron Treatment Centers in Wernersville, Penn. Meth is a very addictive substance because it triggers a huge spike in levels of the feel-good brain chemical dopamine, he said.
Garbely is concerned that the pandemic may have only worsened this already grave situation. "The COVID-19 pandemic has two hidden epidemics: substance use disorder including meth use out West, and mental health disorders," he said. "These two epidemics are hidden by pandemic, and isolation is the fuel that has increased them."
Many treatment centers were closed during the early stages of the pandemic, which may have prevented people from getting help for substance abuse, added Dr. Scott Krakower, an attending psychiatrist with Zucker Hillside Hospital in Glen Oaks, N.Y. "Calling attention to risk for heart failure may help motivate some people to stop using meth," he noted.
Learn more about heart failure and its treatments at the American Heart Association.
SOURCES: Susan Zhao, MD, cardiologist, Santa Clara Valley Medical Center, San Jose, Calif.; Aeshita Dwivedi, MD, cardiologist, Lenox Hill Hospital, New York City; Scott Krakower, DO, attending psychiatrist, Zucker Hillside Hospital, Glen Oaks, N.Y.; Joseph Garbely, DO, chief medical officer, executive vice president, medical research and education, Caron Treatment Centers, Wernersville, Penn.; Circulation: Cardiovascular Quality and Outcomes, July 14, 2021