Doctors call for closer monitoring of patients who practice recreational drug use

NEW YORK, Aug. 30 (UPI) -- The findings of a study, to be presented officially Saturday in London, have prompted doctors to call for closer monitoring of recreational drug use in patients, especially those with a history of heart problems.

Among patients admitted to intensive cardiac care units, recent recreational drug users had a far greater risk of another serious cardiovascular incident, including death, within one year, the study has found.

The findings -- to be discussed at the European Society of Cardiology Congress 2024 -- cast the spotlight on recreational drugs' negative impact on cardiovascular health.

"There is a need for better detection of recreational drug use," the study's lead author, Dr. Raphaël Mirailles, a cardiology resident at Lariboisiere Hospital in Paris, told UPI via email.

"Considering drug use as a risk factor in patients hospitalized for an acute cardiovascular event might favor personalized care to prevent future cardiac events and drug withdrawal," Mirailles said.

"Moreover, at a time of increasing medical use for cannabis, these results highlight the need for a cautious cardiological follow-up of these patients."

Systematic urine screening for recreational drugs among patients hospitalized in intensive cardiac care units revealed that 11% had recently used the chemical substances, Mirailles said.

"Cannabis and opioids use were strongly associated with the occurrence of serious cardiac events," he said. "To our knowledge, this is the first study to show such results."

The researchers previously established that a recent history of recreational drug use correlated with a higher rate of in-hospital mortality, readmissions and long length of stay. Yet, uncertainty persists over the long-term effects of recreational drug use on the cardiovascular system.

Increasing evidence points to a worse prognosis for recreational drug users, not only in cardiac intensive care units, but also in conventional ICUs, Mirailles said.

"Of note, the U.S. is currently facing serious issues with the opioid crisis, but France is not spared as there was a recent increase in cannabis and opioids use," he said.

Despite a high rate of substance abuse under-reporting, current guidelines do not recommend systematic screening. He suggested that clinicians consider such testing in ICUs because it could help stratify patients based on risk, he said.

For this study, researchers included all consecutive patients admitted to intensive cardiac care units over two weeks in April 2021 at 39 centers across France.

At one year, the follow-up entailed a clinical visit or direct contact with patients and referring cardiologists.

The researchers tracked patients to see if they experienced a serious cardiac event -- cardiovascular death, nonfatal heart attack or stroke. They performed a subgroup analysis of patients hospitalized at the outset for acute coronary syndrome -- a non-fatal heart attack or chest pain spanning more than 20 minutes.

Of the 1,499 patients, 1,392 individuals (93%) underwent a complete one-year follow-up. Their average age was 63 and 70% were male.

A total of 157 patients (11%) had an initial positive test for recreational drug use -- cannabis, opioids, cocaine, amphetamines or 3,4-methylenedioxymethamphetamine (MDMA).

The positive results included 136 (9.8%) for cannabis, 32 (2.3 %) for heroin and other opioids, 23 (1.7%) for cocaine, nine (0.6%) for amphetamines and nine (0.6%) for MDMA (active ingredient in ecstasy).

More than one-quarter of patients -- 45 (28.7%) -- tested positive for two or more of these drugs.

While the test for each drug only provided a positive or negative result, there had to be a significant presence of one or more chemical substances for a test to be positive.

Because the urine drug test remained positive two to six days after substance use, it primarily showed recent use rather than regular exposure. On the flip side, an increase in major adverse events at one year could suggest chronic use.

After one year of follow-up, 94 (7%) patients had a serious cardiovascular event, including death. Patients with positive tests incurred a higher rate of serious cardiovascular events than non-users (13% compared to 6%, respectively) -- a significant finding.

The researchers adjusted for multiple variables, such as age, sex, diabetes, current smoking status, history of cardiovascular disease before hospitalization, known chronic kidney disease, history of cancer, the main diagnosis at admission, and the initial measurements for systolic blood pressure and heart rate.

ln the subgroup analysis of 713 patients hospitalized at the outset for acute coronary syndrome, 96 (14%) had a positive recreational drug test and 50 (7%) experienced serious cardiovascular events.

"With how steeply the rate of recreational drug use has been increasing in the U.S., this study is particularly timely," said Dr. Leila Haghighat, a cardiologist and volunteer assistant clinical professor of medicine at the University of California-San Francisco. She was not involved in the study.

"It adds evidence to our growing appreciation of the broad association between recreational drug use and cardiovascular issues, with extra attention paid to the breakdown of risk by drug type," Haghighat said, while noting that the study still has limitations.

In addition to being relatively small, she said the study was conducted only in France, where drug use patterns may be different than in the United States.

Marijuana was by far the most commonly used drug in the study, but it had the weakest association with complications. Haghighat said. It was surprising that opioid use was strongly associated with adverse outcomes, resulting in more than triple the risk of cardiovascular complications at one year.

"While using cannabis, cocaine or amphetamines has more widely been accepted as elevating the risk of heart attack, the same cannot be said for opioids," she added.

Dr. Leslie Cho, section head for preventive cardiology at Cleveland Clinic, said that as cannabis has gained increasing popularity, people think the drug is safe because it's legal in many states.

However, multiple studies have shown that people who use marijuana have more heart attacks regardless of whether they smoke, ingest or vaporize the substance.

"This is a confirmation of that finding," she said. "We're just beginning to learn of its effect on the cardiovascular system."

More research is needed, Cho pointed out, before reaching a sound conclusion.

"This is not a definitive study, but it's very compelling," she said, suggesting that people with cardiovascular disease risk factors, such as family history, high blood pressure or diabetes, talk with their primary care doctor before using marijuana.