Noubiap Jean Jacques, Dewland Thomas A, Montenegro Gabrielle C, Oo Hannah H, Tseng Zian H, Marcus Gregory M
Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
Eur Heart J. 2025 Oct 1;46(37):3639-3647. doi: 10.1093/eurheartj/ehaf282.
Ventricular tachycardia and ventricular fibrillation underlie many sudden cardiac deaths, but common lifestyle factors that predict their occurrence are poorly understood. This study aimed to assess the association between methamphetamine and cocaine, the most used illicit stimulants, and ventricular arrhythmias (VA) and mortality.
Healthcare databases were used to identify adults aged ≥ 18 years receiving hospital-based care in California in 2005-2019. ICD codes were used to identify diagnoses and illicit stimulant use. Cox proportional hazard models adjusting for demographics and time-updated cardiovascular risk factors were employed. The outcomes were VA combining ventricular tachycardia, ventricular fibrillation, and cardiac arrest and all-cause mortality.
Among 29 593 819 individuals (53.8% female, mean age 44.9 years), 690 737 (2.3%) used methamphetamine, and 290 652 (1.0%) used cocaine at some point. After adjustment for age, sex, race and ethnicity, cannabis and opioid use, and other cardiovascular risk factors, methamphetamine use and cocaine use were each associated with increased risk of incident VA [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.85-1.95, and HR 1.15, 95% CI 1.10-1.19, respectively], and mortality (HR 1.51, 95% CI 1.47-1.54 and HR 1.68, 95% CI 1.64-1.72, respectively). The risk of VA was higher in younger individuals (<65 years) and females for both methamphetamine and cocaine, whereas it was higher in Blacks and lower in Whites and Hispanics for cocaine use, and higher in Asians and lower in Blacks for methamphetamine use (P for interaction < .05 in all).
Methamphetamine use and cocaine use were each associated with increased risk of incident VA and mortality, with differential relationships by demographic groups. Avoiding these substances may reduce risk of VA and death.
室性心动过速和心室颤动是许多心源性猝死的原因，但对预测其发生的常见生活方式因素知之甚少。本研究旨在评估最常用的非法兴奋剂甲基苯丙胺和可卡因与室性心律失常（VA）及死亡率之间的关联。
利用医疗保健数据库识别2005年至2019年在加利福尼亚州接受住院治疗的18岁及以上成年人。使用国际疾病分类代码来识别诊断和非法兴奋剂使用情况。采用Cox比例风险模型对人口统计学和随时间更新的心血管危险因素进行调整。结局指标为合并室性心动过速、心室颤动和心脏骤停的VA以及全因死亡率。
在29593819名个体（53.8%为女性，平均年龄44.9岁）中，690737人（2.3%）曾使用甲基苯丙胺，290652人（1.0%）曾使用可卡因。在调整年龄、性别、种族和民族、大麻和阿片类药物使用以及其他心血管危险因素后，甲基苯丙胺使用和可卡因使用均与新发VA风险增加相关[风险比（HR）分别为1.90，95%置信区间（CI）为1.85 - 1.95，以及HR 1.15，95% CI为1.10 - 1.19]，且与死亡率相关（HR分别为1.51，95% CI为1.47 - 1.54以及HR 1.68，95% CI为1.64 - 1.72）。甲基苯丙胺和可卡因使用者中，年轻人（<65岁）和女性发生VA的风险更高，而可卡因使用者中黑人的风险更高，白人和西班牙裔的风险较低，甲基苯丙胺使用者中亚洲人的风险更高，黑人的风险较低（所有交互作用P均<0.05）。
甲基苯丙胺使用和可卡因使用均与新发VA风险增加及死亡率相关，不同人群之间存在差异关系。避免使用这些物质可能会降低VA和死亡风险。
