Alarming Increase in Substance Use-Related Cardiovascular Death, Study Finds

A new study led by a Loma Linda University Health researcher reveals a concerning trend in cardiovascular disease (CVD) deaths associated with substance use, with an annual 4-percent increase from 1999 to 2019, despite an overall decline in CVD mortality during the same period.

The findings, recently published in the Journal of the American Heart Association, underscore the urgent need for targeted preventive measures, especially among high-risk populations.

The research, conducted by cardiologist and associate professor of medicine Dmitry Abramov, was an analysis of data from the U.S. Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) database. The study uncovered several alarming trends related to substance use and cardiovascular deaths.

Some of the key findings of the study included the fact that alcohol was the most common substance associated CVD deaths, followed by opioids, cocaine, and other illicit drugs. The study also found that despite an overall drop in CVD deaths between 1999 and 2019, substance use–related CVD deaths increased by 4 percent annually during this time, accelerating to 6.2 percent from 2012 to 2019. Significant increases were observed among women, American Indian or Alaskan individuals, younger adults (25-59 years), rural residents, and users of cannabis and psychostimulants.

Abramov emphasized the clinical relevance of the results. “The study results were generally consistent with what we see in our clinic while caring for patients with cardiovascular disease, with many patients who are dying of cardiovascular disease also having concomitant substance use,” he said.

Between 1999 and 2019, the study identified a staggering 636,572 substance use and CVD-related deaths, with men constituting 75.6 percent of the cases. Most deaths occurred among non-Hispanic White individuals (70.6 percent), and 65 percent were related to alcohol use. Notably, age-adjusted mortality rates per 100,000 population were significantly pronounced in men, American Indian or Alaska Native individuals, nonmetropolitan/rural areas, and alcohol-related cases.

“While the rates of cardiovascular disease mortality related to substance use were higher in men than women, women demonstrated larger increases during the study period,” Abramov said. “These sex-based differences, in addition to the differences by race and ethnicity, age, and living in an urban or rural community, require additional research.”

Notably, the study highlighted a particularly rapid increase in CVD deaths associated with stimulant use, primarily amphetamines. This emphasizes the need to address emerging risks posed by substances beyond alcohol and opioids.

The limitations, including potential miscoding errors on death certificates and the lack of information on cardiovascular disease risk factors, highlight the need for further research. Abramov calls for additional public health efforts to comprehensively address substance use, including clinician and patient education and attention to socioeconomic factors contributing to substance use.

The original version of this story was posted on the Loma Linda University Health news site.