How do Drugs (Substance Abuse) Affect the Cardiovascular System?

Chronic abuse of alcohol or drugs increases the probability of a person developing heart disease and other significant problems that affect the body’s cardiovascular system.1 The cardiovascular system, also commonly referred to as the circulatory system, includes the heart, which pumps oxygen-rich blood to organs via the arteries and removes wastes products such as carbon dioxide via the veins.

Effects of Recreational Drugs on The Cardiovascular System

inside rendering of cardiovascular systemAlcohol or drug use can contribute to the following cardiovascular issues:

  • Arrhythmia, when the heart’s rhythm is abnormal.2 The heart may beat too fast (tachycardia), too slow (bradycardia), or beat irregularly, such as when a heart “skips a beat.”2
  • Endocarditis is inflammation of the inner lining of the heart’s chambers or the valves. Endocarditis may lead to arrhythmias, blood clots, valve damage or heart failure.3
  • High blood pressure (hypertension), which makes the heart work harder than normal.4 Chronic hypertension can cause other issues, including heart attack, stroke, heart failure, and issues with the kidneys.4, 5
  • Heart attack, when the heart is beating but atherosclerosis (a buildup of plaque in the arteries) causes a blockage, preventing blood from flowing into the heart.2 Heart attacks increase the risk of cardiac arrest, which is an electrical malfunction of the heart that causes an arrhythmia.6
  • Cardiomyopathy, or thickening of the heart muscle, which and can impair the heart’s ability to pump blood throughout the body.7 Cardiomyopathy can lead to arrhythmias, heart failure, issues with heart valves, and cardiac arrest.7
  • Heart failure, which occurs when the heart isn’t able to pump sufficient blood to meet the needs of the body.8
  • Peripheral artery disease (PAD), which occurs when blood vessels in the body are narrowed or blocked as a result of atherosclerosis, leading to slowed or stopped blood flow to the legs or arms.9 In severe cases, this can cause infection and may require amputation.9
  • Stroke, which occurs when blood flow to an area of the brain is blocked by plaque or other substances.10 A stroke can cause damage to the brain or death.10

What Does Cocaine Do To Your Heart?

Stimulants such as cocaine affect the cardiovascular system.1, 11, 12 Cardiovascular problems can occur from both short-term and chronic use of stimulants, and chest pain is a common complaint in those seeking treatment.1, 5, 11, 13

Cocaine is the illicit drug most likely to cause an emergency room visit, responsible for 57% of recreational substance-related emergency room visits.14 use can lead to arrhythmias, cardiac arrest, cardiomyopathy, hypertension, heart attack, and stroke.1, 11, 12, 13

Studies show that cocaine use:

  • Is a factor in 25% of heart attacks among people between the ages of 18 and 45.15
  • Makes a person almost 24 times as likely to experience a heart attack.16
  • Leads to higher blood pressure.17
  • Leads to a 30-35% increase in stiffening of the arteries.17

Intravenous use of cocaine has a higher risk of overdose and a fatal outcome than other methods of consumption. IV drug use also carries the risk of developing infective endocarditis. Fatal cocaine overdose is often caused by seizures, cardiac arrhythmias, respiratory insufficiency, and stroke.18

Cardiovascular Effects of Stimulant Abuse

Other stimulants, such as crystal meth and amphetamines such as Adderall and Ritalin, have similar effects on the cardiovascular system.1, 12 Arrhythmias, cardiac arrest, hypertension, heart attack, and stroke are all related to stimulant use.1, 11, 15

Cardiovascular problems can occur from both short-term and chronic use of stimulants. 1, 5, 11, 13 2, 6, 11 Stimulants such as amphetamines can cause the same problems for the cardiovascular system that cocaine does, including acute and chronic diseases and even sudden death.19

  • Hypertension—high blood pressure—can be caused or exacerbated by the use of stimulants such as amphetamines.20
  • People who abuse amphetamines have shown signs of premature aging of their cardiovascular system.21
  • Methamphetamine users risk premature coronary artery disease and cardiomyopathy.11

What Does Alcohol Do To The Cardiovascular System?

man drinking liquor at a barWhile drinking small amounts of alcohol can lower the risk of some types of cardiovascular disease, alcohol in larger amounts can have a negative effect on cardiovascular health.1, 11, 23 Binge drinking (5 or more drinks in one sitting) and chronic alcohol use can cause a variety of cardiovascular issues, including arrhythmias, cardiomyopathy, hypertension, heart attack, PAD, and stroke.1, 11, 23, 24, 25

Young people who binge drink are also at increased risk of having a stroke.25 Consistently having more than 5 drinks daily increases the risk of experiencing heart failure.25

Studies on how alcohol affects cardiovascular health suggest that:

  • Having more than 6 drinks daily doubles the risk of experiencing hypertension.25
  • Binge drinking raises the risk for a heart attack for up to 24 hours.25
  • Heavy drinkers are approximately 1.5 times more likely to die from a stroke.25
  • People who abuse alcohol are twice as likely to experience arrhythmia.26
  • People who abuse alcohol are 1.4 times more likely to have a heart attack.26
  • People who abuse alcohol are 2.3 times more likely to experience heart failure.26
  • People who have 10 or more drinks each week die 1-2 years sooner than people who have 5 or fewer drinks each week.27
  • People who have 18 or more drinks each week die 4-5 years sooner than people who have 5 or fewer drinks each week.27
  • In the U.S., alcohol abuse causes 73,000 cases of arrhythmia, 34,000 heart attacks, and 91,000 cases of heart failure a year.26

How Does Tobacco Affect The Cardiovascular System?

Many studies have shown that tobacco use harms physical health.5, 11, 28 Compared to substances that may be used on an irregular basis, tobacco use often occurs consistently throughout the day, and the impact on physical health may not be noticed until a person has been using tobacco for a long time.5, 11 Some of these changes are irreversible.28

Tobacco use can contribute to cardiovascular disease through changes that cause plaque to build up in the arteries. This buildup makes it difficult for the blood to flow, thus leading to hypertension and reduced blood flow to various organs, including the heart and brain.28 The cardiovascular conditions most often associated with tobacco use are hypertension, heart attack, PAD, and stroke.11, 28, 29

Statistics show that:

  • Smoking causes nearly half a million deaths each year in the U.S.30
  • Tobacco use is the primary preventable cause of PAD.28
  • Of the approximately 800,000 U.S. deaths a year from cardiovascular disease, almost 160,000 (20%) are caused by smoking cigarettes.28
  • People in the U.S. who smoke are 3 times more likely to die than people who don’t smoke.30
  • The life expectancy for people who smoke is 10 years shorter than people who do not smoke.30

Quitting tobacco products can lower a person’s risk of cardiovascular disease and premature death.30, 31 The risk of dying from a disease caused by smoking drops by around 90% if a person quits tobacco before turning 40.30 Within a year of quitting smoking, the risk of having a heart attack drops dramatically.31

For people who have had a heart attack, quitting lowers the risk of having additional heart attacks by one third to a half.31 Within 5 years after quitting, the risk of having a stroke is similar to that of nonsmokers.31

Opioids and Heart Rate

Abusing opioids, such as prescription pain medications or heroin, can cause cardiovascular disease.11, 12 The most common cardiovascular issues related to opioid use are arrhythmias and stroke.12, 32 In addition, people who inject opioids are at increased risk for developing endocarditis, a dangerous bacterial infection of the heart.11, 32, 33 More than one episode of endocarditis increases the risk of heart attack and stroke.34

Statistics on cardiovascular disease and opioids show that:

  • Opioid use increased the risk of arrhythmia by 34% in a study of nearly 900,000 military veterans that were middle-aged or younger.32
  • Fatal cases of endocarditis in people who injected substances doubled in people under age 35 between 1999 and 2016.33
  • People who have been operated on for endocarditis due to substance use are 10 times more likely to die or require additional operations if they continue to inject substances.33

Marijuana and Heart Disease

Cannabis affects both heart rate and blood pressure, which could potentially elevate some cardiovascular risks in people who may already be vulnerable to chest pain, high cholesterol, heart attack and stroke although more conclusive research is needed.35

It’s Not Too Late to Get Help

If you or a loved one is struggling with substance abuse, it can be scary to realize all the damage that can be done to the body. However, it’s never too late to do something about it. Getting help to stop using can lower the risk of developing cardiac issues and improve any issues that may have already occurred. If you or a loved one are ready to quit, give us a call at 973-862-4820.

Quitting substances isn’t an easy process, but with the right support and treatment, it is possible to stop using and improve your health.

 

Resources:

  1. O’Connor, A.D., Rusyniak, D.E., & Bruno, A. (2005). Cerebrovascular and cardiovascular complications of alcohol and sympathomimetic drug abuse. Medical Clinics of North America, 89(6), 1343-1358.
  2. U.S. National Library of Medicine. (2016). Cardiac arrest.
  3. Rudasill, S.E., Sanaiha, Y., Mardock, A.L., Khoury, H., Xing, H., Antonios, J.W., McKinnel, J.A., & Benharash, P. (2019). Clinical outcomes of infective endocarditis in injection drug users. Journal of the American College of Cardiology 73(5), 559-570.
  4. U.S. National Library of Medicine. (2018). High blood pressure.
  5. Kaplan, E.H., Gottesman, R.F., Llinas, R.H., & Marsh, E. (2014). The association between specific substances of abuse and subcortical intracerebral hemorrhage versus ischemic lacunar infarction. Frontiers in Neurology, 5(174), 1-5.
  6. American Heart Association. (n.d.). Heart attack or sudden cardiac arrest: how are they different?
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  8. U.S. National Library of Medicine. (2019). Heart failure.
  9. U.S. National Library of Medicine. (2016). Peripheral arterial disease.
  10. U.S. National Library of Medicine. (2018). Stroke.
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  13. Morgan, J.P. (2020). Clinical manifestations, diagnosis, and management of the cardiovascular complications of cocaine abuse.
  14. Finkel, J.B. & Marhefka, G.D. (2011). Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clinic Proceedings 86(12), 1198-1207.
  15. Qureshi, A.I., Suri, F.K., Guterman, L.R., & Hopkins, L.N. (2001). Cocaine use and the likelihood of nonfatal myocardial infarction and stroke. Circulation, 103(4), 502-506.
  16. Finkel, B., & Marhefka, G.D. (2011). Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clinic Proceedings, 86(12), 1198-1207.
  17. American Heart Association. (2020). Illegal drugs and heart disease.
  18. Petkovska, L., Chibishev, A., Stevcevska, A., Smokovski, I., Petkovski, D., & Antova, (2017). Multi-system complications after intravenous cocaine abuse. Open Access Macedonian Journal of Medical Sciences 5(2), 231-235.
  19. Frishman, W.H., Del Vecchio, A., Sanal, S., & Ismail, A. (2003). Cardiovascular manifestations of substance abuse: part 2: alcohol, amphetamines, heroin, cannabis, and caffeine. Heart Disease 5(4), 253-271.
  20. Bazmi, E., Mousavi, F., Giahchin, L., Moktari, T., Behnoush, B. (2017). Cardiovascular complications of acute amphetamine abuse. Sultan Qaboos University Medical Journal 17(1), e31-337.
  21. Reece, A.S., Norman, A., & Hulse, G.K. (2017). Acceleration of cardiovascular-biological age by amphetamine exposure is a power function of chronological age. Heart Asia 9(1), 30-38.
  22. Kaye, S. & McKetin, R. (n.d.). Cardiotoxicity associated with methamphetamine use and signs of cardiovascular pathology among methamphetamine users.
  23. Wakabayashi, I., & Sotoda, Y. (2014). Alcohol drinking and peripheral arterial disease of lower extremity. Nihon Arukoru Yakubutsu Igakkai Zasshi, 49(1), 13-27.
  24. Hu, N., Zhang, Y., Nair, S., Culver, B.W, & Ren, J. (2014). Contribution of ALDH2 polymorphism to alcoholism-associated hypertension. Recent Patents on Endocrine, Metabolic, and Immune Drug Discovery, 8(3), 180-185.
  25. Piano, M.R. (2017). Alcohol’s effects on the cardiovascular system.
  26. Alcohol Research: Current Reviews, 38(2), 219-241.American College of Cardiology. (2017). Alcohol abuse increases risk of heart conditions as much as other risk factors.
  27. Harvard Health B (2018). Alcohol and heart health.
  28. U.S. Food and Drug Administration. (2020). How smoking affects heart health.
  29. Pineda, J.R., Kim, E.S., & Osinbowale, O.O. (2015). Impact of pharmacologic interventions on peripheral artery disease. Progress in Cardiovascular Disease, 57(5), 510-520.
  30. Centers for Disease Control and Prevention. (2018). Tobacco-related mortality.
  31. Centers for Disease Control and Prevention. (2010). Highlights: Overview of findings regarding cardiovascular disease.
  32. American Heart Association. (2019). Concerns about heart health amid the opioid, meth epidemic.
  33. Kadri, A.N., Wilner, B., Hernandez, A.V., Nakhoul, G., Chahine, J., Griffin, B., … Harb, S.C. (2019). Geographic trends, patient characteristics, and outcomes of infective endocarditis associated with drug abuse in the United States from 2002 to 2016. Journal of the American Heart Association, 8(19), 1-10.
  34. Shih, C-J., Chu, H., Chao, P-W., Lee, Y-J., Kuo, S-C., Li, S-Y., … Chen, Y-T. (2014). Long-term clinical outcome of major adverse cardiac events in survivors of infective endocarditis: A nationwide population-based study. Circulation, 130(19), 1684-1691.
  35. R, D., Ghasemiesfe, M., Korenstein, D., Cascino, T., & Keyhani, S. (2018). Associations between marijuana use and cardiovascular risk factors and outcomes. Annals of Internal Medicine 168(3), 187-194.
About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More