A recent study reveals that between 1999 and 2019, the average annual rise in mortality from cardiovascular disease, including substance use, was 4%, despite a drop in total cardiovascular disease deaths over that period

“The results are concerning, as they mark a significant upward trend in cardiovascular deaths where substance abuse was noted,” said Dr. Sameer Amin, cardiologist and chief medical officer at L.A. Care Health Plan, who was not involved with the new research.

“Considering this is in the midst of an overall decrease in cardiovascular death during that time period, this appears to be an exception to our progress in treating cardiac disease,” he said.

The study’s data, as noted by Dr. Cheng-Han Chen, an interventional cardiologist and the medical director of MemorialCare Saddleback Medical Center in Laguna Hills, California’s Structural Heart Program, only extends to 2019, right before the COVID-19 epidemic broke out.

“There have been data pointing out that substance use and abuse have worsened starting in 2020 with the pandemic,” said Chen, who was not involved in the new study. So “it’s concerning to think that this trend may be getting worse in more recent years.”

The new study, which discovered substance use as a factor in increasing heart-related death, was published on January 10 in the Journal of the American Heart Association.

Many Substances Linked To Cardiovascular Disease

Study: Substance Use, Especially Alcohol, Increasing Heart-Related Deaths
Study: Substance Use, Especially Alcohol, Increasing Heart-Related Deaths

The study examined changes in the mortality toll from cardiovascular disease from 1999 to 2019 using publicly accessible data from the Wide-Ranging Online Data for Epidemiologic Research (WONDER) database of the Centers for Disease Control and Prevention.

Researchers discovered that the rate of cardiovascular mortality linked to substance use rose by 4% per year, from 9.9 per 100,000 people in 1999 to 21.4 per 100,000 people in 2019. Even more quickly, from 2012 to 2019, the mortality rate rose to 6.2%.

In contrast, researchers discovered that the annual average rate of fatalities from cardiovascular disease dropped by 1.5%.

The researchers noted that many drugs, including alcohol, opioids, stimulants, sedatives, and cannabis, raise the risk of cardiovascular illness, which includes heart failure, coronary heart disease, and irregular heart rhythms.

Overall, alcohol usage was responsible for 65% of drug-related fatalities from cardiovascular disease. Opioids (13.7%), cocaine (9.8%), stimulants (6.5%), sedatives (4.1%), and cannabis (0.5%) were the next most common substances.

However, the average yearly percent change in cardiovascular disease fatalities attributable to substance use was larger among those who used cannabis (12.7%) and psychostimulants such as amphetamines (16.8%).

“It’s troubling to see that there have been increases in cardiovascular disease mortality with all different types of substances, not only the most commonly used substance, alcohol,” Chen said.

Tobacco usage and smoking were not considered forms of substance use in the study. Heart disease, stroke, and other chronic illnesses, as well as lung and other malignancies, are associated with smoking.

Researchers did not have information about other cardiovascular disease risk factors, such as a condition like type 2 diabetes or high blood pressure, or whether people had a family history of the disease, even though the findings show long-term trends in deaths from cardiovascular disease linked to substance use.

Who is Most Impacted by Cardiac Deaths Due To Substance Use?

Study: Substance Use, Especially Alcohol, Increasing Heart-Related Deaths
Study: Substance Use, Especially Alcohol, Increasing Heart-Related Deaths

The results of the current study indicate that particular categories were disproportionately affected by substance-related mortality from cardiovascular disease.

For instance, increases in the average annual percent change for mortality rates were greater for persons who identified as American Indian or Alaskan (5.4%); individuals between the ages of 25 and 59 (5.3%); individuals residing in rural regions (5.0%); adults between the ages of 55 and 69 (4.9%); and women (4.8%).

“I am particularly concerned at the disparities in outcomes for women, American Indian/Alaskan individuals, and rural area residents,” said Amin. This “could represent healthcare inequities in our system.”

Those who lived in rural regions had a higher death rate (15.2 per 100,000) than those who lived in urban areas (14.1 per 100,000). It was also greater for men (22.5 per 100,000) than women (6.8 per 100,000).

Researchers discovered that although men’s death rates were higher than women’s over the study period, women’s rises were greater.

“Data from prior studies have found notable increases in substance use among women over the last 20 years, and women may face unique societal risks that may contribute to the increases noted in our study,” study author Dr. Dmitry Abramov, cardiologist and associate professor of medicine at Loma Linda University Health in Loma Linda, Calif., said in a news release.

Furthermore, rates varied between racial and ethnic groupings.

Compared to black adults (20.3 per 100,000), white adults (14.1 per 100,000), Hispanic adults (13.0 per 100,000), Asian adults or Pacific Islanders (3.6 per 100,000), and American Indian or Alaska Native adults (37.7 per 100,000), the highest death rate was among these groups.

According to Chen, knowing which populations are most impacted by drug-associated mortality from cardiovascular disease might help focus public health initiatives on lowering drug use and related health consequences in these populations.

Amin is worried about what has transpired since then, in addition to the patterns that have continued into 2019. Specifically, he emphasized that certain groups seem to be on the rise, beginning around the time of the financial crisis of 2007–2008.

“If this is associated with an increase in socioeconomic inequality and a widening gap in economic disparity [between certain groups] during that time, we have to be particularly vigilant post-COVID pandemic,” he said. “The effects of the post-COVID economic environment could potentially exacerbate the gap.”

Researchers looked at trends in the mortality toll from cardiovascular disease between 1999 and 2019 using CDC data. They paid particular attention to drug-related fatalities.

Despite a decline in total cardiovascular disease mortality during that time, the number of deaths from cardiovascular disease related to drug use climbed by 4% year on average, with a quicker increase from 2012 to 2019.

Deaths from cardiovascular disease related to substance use rose more quickly in women, those who identify as American Indian or Alaskan, younger adults, people living in rural areas, and people who used cannabis or psychostimulants.

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