BACKGROUND

Cocaine and methamphetamine, highly cardiotoxic stimulants, are associated with increased risks of hypertension, coronary artery disease, arrhythmias, cardiomyopathy, and stroke.

OBJECTIVES

This study examines trends in stimulant-involved cardiovascular disease (CVD) mortality in the U.S. from 2014 to 2023, analyzing CVD subtypes, stimulant type, population characteristics, and years of life lost (YLL).

DESIGN

Trend analysis of age-adjusted mortality rates using serial cross-section mortality data from 2014 to 2023.

METHODS

Using National Vital Statistics System data, we analyzed age-adjusted mortality rates (AAMRs) where CVD was the underlying cause of death and stimulants were contributing factors. We used Joinpoint regression to estimate average annual percent change (AAPC) and compare trends across groups. We calculated YLL based on age at death and demographic-specific life expectancies.

RESULTS

From 2014 to 2023, stimulant-involved CVD mortality rose sharply (AAPC: 10.1%), contrasting with stable rates of overall CVD mortality (AAPC: 0.2%). Methamphetamine-involved deaths increased faster (AAPC: 13.8%) than cocaine-involved deaths (AAPC: 6.5%). Among CVD subtypes, cerebrovascular disease showed the steepest rise (AAPC: 15.9%), followed by hypertensive (12.1%) and ischemic heart diseases (7.9%). Older adults (⩾65 years) exhibited the most pronounced increase in stimulant-involved CVD mortality (AAPC: 20.2%), while non-Hispanic American Indian/Alaska Native populations experienced the highest AAPC among racial/ethnic groups (18.1%). Stimulant-involved CVD caused nearly 1 million years of YLL, predominantly among middle-aged males (687 430 YLL) and non-Hispanic White individuals (511 120 YLL). Methamphetamine involvement (580 570 YLL) exceeded that of cocaine (423 528 YLL). Within CVD types, ischemic heart disease was the leading cause (406 248 YLL).

CONCLUSIONS

Stimulant-involved CVD mortality has surged, especially among non-Hispanic American Indian/Alaska Native and non-Hispanic White populations and older adults, with cerebrovascular disease showing the largest increase among CVD subtypes. The findings reveal the importance of targeted prevention, screening, and intervention.