Amphetamine abusers face blood vessel risk

The new findings appear in the August American Heart Journal.

An aortic tear, also called aortic dissection, brings on “the most horrible chest pain imaginable,” says David Waters, a cardiologist at San Francisco General Hospital and the University of California, San Francisco. “Patients say, ‘I think I’m going to die,’ and they’re right,” he says. Without treatment, the fatality rate is ultimately about 75 percent, according to the Merck Manual Online.

In the new study, researchers scanned the medical records of nearly 31 million patients nationwide, ages 18 to 49, who were hospitalized between 1995 and 2007. Codes on these records showed that 3,116 had an aortic dissection. The researchers also took note of codes that revealed amphetamine abuse or dependence. Use of methamphetamines, an increasingly popular street drug, would show up in the codes as amphetamines.

Amphetamine abusers faced 3.3 times the risk of developing a torn aorta that nonusers did, the data showed. Researchers calculated that amphetamine abuse or dependence accounted for slightly less than 1 percent of all aortic dissections in the database.

While that might be a small fraction, the findings nevertheless may help people make better-informed decisions about their behavior, says study coauthor Arthur Westover, a psychiatrist at the University of Texas Southwestern Medical Center at Dallas. Drug users, he says, “have a suspicion that methamphetamines are bad for their health, but I don’t think kids are doing a specific risk-benefit analysis in their minds when they start.”

Young people who show up at a hospital with chest pains often appear too young to be having a heart attack, adds Waters, who was not part of the study, so clinicians might not suspect a vascular problem such as an aortic tear. “It would be good if doctors thought of this possibility more,” he says. Amphetamine abuse can be easily detected by a urine test. Aortic tears require imaging such as a chest X-ray or CT scan, or other tests for a clear diagnosis.

Aortic tears occur most often in older people, at an average age of about 62, says University of Michigan cardiologist Kim Eagle, who has founded an international registry of aortic dissections. He puts the new findings in perspective this way: There are roughly 10,000 aortic dissections in the United States every year, and less than one-fourth occur in people younger than middle age. Of those, 1 percent or fewer appear linked to amphetamine abuse, according to these data. He adds that smoking and use of illicit drugs, such as cocaine, also contribute to this risk.

People with chronic high blood pressure are known to be at high risk of aortic tears. Amphetamines trigger adrenaline release, which revs up blood pressure and may explain, in part, the link between the drugs and aortic tears, Eagle says.

A patient with an aortic tear is treated with medication to lower blood pressure and lessen the strain on the aorta. Often, the condition requires surgery to install a synthetic graft that replaces the damaged vessel and other measures to repair the tear. Eagle estimates the overall fatality rate of all patients, treated and untreated combined, to be about one in four.