To Magnus, Savoj Javad, Kraft Joseph, Chang Joseph, Ayutyanont Napatkamon, Vandeveer Christian, Gulati Rajesh, Biswas Mimi
Cardiology, Riverside Community Hospital, Riverside, USA.
Internal Medicine, Riverside Community Hospital, Riverside, USA.
Cureus. 2024 Dec 27;16(12):e76479. doi: 10.7759/cureus.76479. eCollection 2024 Dec.
Methamphetamine abuse is a public health problem across the world, and the cardiovascular system experiences a significant effect on the myocardium over time. Methamphetamine is a common cause of heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). The prevalence and risk factors for HFpEF and HFrEF in this patient population remain unclear.
This retrospective case-control study is based on a chart review of patients from 139 Hospital Corporation of America (HCA) community hospitals across the United States from January 2013 to December 2017. Active methamphetamine users were identified based on International Classification of Diseases (ICD) codes and a positive urine drug screen during hospitalization. The total number of patients was then divided into two groups: heart failure (HF) vs. no HF. Then exclusion criteria were applied to remove any possible characteristics that might confound the data. The number of patients left was then analyzed.
This study identified 9,518 active methamphetamine users, with 403 patients (4.23%) having HF, 41 having unspecified HF, and 51 having HFpEF only, vs. 311 having HFrEF only, compared to 9,115 in the control group without HF. After exclusion criteria were applied, the HF group had 166 patients, and the control group had 398 patients. Heart failure was significantly higher in men, 65.7% men compared to 34.3% women (adjusted odds ratio (OR): 1.894, p = 0.022). The average ages of HF group patients before exclusion criteria, after exclusion criteria, and in the control group were 52.5 years, 46.5 years, and 42.7 years, respectively. The age difference between the HF group (average 46.5 years old) and the control group (average 42.7 years old) was not statistically significant (adjusted OR: 1.007, p = 0.540). However, the average age of the HFpEF population significantly differs from the HFrEF population, 70.2 years old compared to 47.1 years old, respectively (adjusted OR: 1.053, p = 0.001). Female patients appeared to be more likely to have HFpEF (70.6%) compared to HFrEF (18.9%, adjusted OR: 3.738, p < 0.001).
Amongst methamphetamine users who develop HF, men appeared to be affected more compared to women. This difference may stem from the differences in activities between men and women. On the other hand, age appeared to not play a role when viewing the entire HF group as a whole. However, when broken down into reduced and preserved groups, age appeared to play a significant role in the type of HF that methamphetamine users may develop. The HFpEF age in methamphetamine users appeared to follow the trend of the general population age with HFpEF. The HFrEF rate was about six times higher among methamphetamine users, excluding the population with unspecified HF. Higher rates of methamphetamine abuse are prompting further studies and programs to reduce cardiac morbidity and mortality in this group and decrease the burden on health systems.
甲基苯丙胺滥用是一个全球性的公共卫生问题，随着时间的推移，心血管系统会对心肌产生重大影响。甲基苯丙胺是射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）的常见病因。该患者群体中HFpEF和HFrEF的患病率及危险因素仍不清楚。
这项回顾性病例对照研究基于对2013年1月至2017年12月期间美国139家美国医院公司（HCA）社区医院患者的病历审查。根据国际疾病分类（ICD）编码和住院期间尿液药物筛查呈阳性来确定活跃的甲基苯丙胺使用者。然后将患者总数分为两组：心力衰竭（HF）组和无心力衰竭组。接着应用排除标准去除任何可能混淆数据的特征。随后对剩余患者数量进行分析。
本研究确定了9518名活跃的甲基苯丙胺使用者，其中403例患者（4.23%）患有心力衰竭，41例患有未明确类型的心力衰竭，51例仅患有HFpEF，311例仅患有HFrEF，而对照组无心力衰竭的患者有9115例。应用排除标准后，HF组有166例患者，对照组有398例患者。心力衰竭在男性中显著更高，男性占65.7%，女性占34.3%（调整后的优势比（OR）：1.894，p = 0.022）。排除标准前、排除标准后HF组患者的平均年龄以及对照组患者的平均年龄分别为52.5岁、46.5岁和42.7岁。HF组（平均年龄为46.5岁）与对照组（平均年龄为42.7岁）之间的年龄差异无统计学意义（调整后的OR：1.007，p = 0.540）。然而，HFpEF人群的平均年龄与HFrEF人群显著不同，分别为70.2岁和47.1岁（调整后的OR：1.053，p = 0.001）。与HFrEF（18.9%，调整后的OR：3.738，p < 0.001）相比，女性患者似乎更易患HFpEF（70.6%）。
在发生心力衰竭的甲基苯丙胺使用者中，男性似乎比女性受影响更大。这种差异可能源于男女活动的差异。另一方面，从整个HF组整体来看，年龄似乎不起作用。然而，当分为射血分数降低组和保留组时，年龄似乎在甲基苯丙胺使用者可能发生的心力衰竭类型中起重要作用。甲基苯丙胺使用者中HFpEF的年龄似乎遵循一般人群中HFpEF的年龄趋势。排除未明确类型心力衰竭的人群后，甲基苯丙胺使用者中HFrEF的发生率约高六倍。甲基苯丙胺滥用率的升高促使进一步开展研究和项目，以降低该群体的心脏发病率和死亡率，并减轻卫生系统的负担。
