Acute myocardial infarction in young adults who abuse amphetamines

Abstract

Background: Case reports suggest a link between methamphetamine abuse and acute myocardial infarction (AMI), but no epidemiologic studies have examined this link. Our objective was to test the hypothesis that young adults who abuse amphetamines are at higher risk for AMI.

Methods: In this study of 3,148,165 discharges from Texas hospitals in a quality indicators database during 2000-2003, among persons aged 18-44 years we identified 11,011 AMIs, defined according to the Agency for Healthcare Research and Quality's AMI mortality inpatient quality indicator.

Results: In a multiple logistic regression analysis - while controlling for cocaine abuse, alcohol abuse, tobacco use, hypertension, diabetes mellitus, lipid disorders, obesity, congenital defects, and coagulation defects - amphetamine abuse was significantly associated with AMI (adjusted odds ratio=1.61; 95% CI=1.24-2.04, p=0.0004). The rate of AMIs among amphetamine abusers increased significantly from 2000 to 2003. The population attributable risk suggests that amphetamine abuse is responsible for 0.2% of AMIs in the state of Texas. The geographical distribution of amphetamine abuse varied by region, with the prevalence being highest in the North Texas and Panhandle regions of Texas.

Conclusions: This modest, though statistically robust, association suggests that amphetamine abuse may play a role in AMI.

Figure 1

Geographical distribution of the rates of amphetamine and cocaine abuse and of amphetamine- or cocaine-associated acute myocardial infarction identified in healthcare settings in Texas, 2000–2003 (THCIC) and 2002 (TCADA). Footnote: The prevalence/incidence rates in B, C, E, F and H are the number of patients hospitalized in a given county having the indicated condition in 2000–2003 divided by the number of people 18–44 years of age in the county in the 2000 Census. In A and D, the white areas are counties with missing data or fewer than 20 cases of the indicated condition. In G, population is of people 18–44 years of age; North Texas refers to Public Health Regions 1, 2, and 3; South Texas refers to 5, 6, 8, and 11. TCADA =Texas Council on Alcohol and Drug Abuse.

Figure 2

Trends in AMI, Amphetamine and Cocaine Abuse, and Amphetamine-Associated and Cocaine-Associated AMI Footnote: In discharges of persons 18 to 44 years of age from Texas hospitals, 2000 to 2003. * Incidence of AMI, prevalence rate of amphetamine and cocaine abuse per 1000 discharges (±SE). †Incidence of amphetamine-associated and cocaine-associated AMI per 100,000 discharges (±SE). P values are from the Cochrane-Armitage test for trend (two-tailed).