Pretty much everyone knows that “substance use” — drinking alcohol, smoking tobacco or using other recreational drugs — is unhealthy in a variety of ways. But many people still use them— maybe because they like doing so, maybe because they’re addicted to them, or maybe because they don’t want to think about the long-term consequences. But a new study suggests that when it comes to a common form of cardiovascular disease, those consequences might not always be too far ahead in the future.
Since people with diabetes are already at a higher risk for cardiovascular disease — and often develop it at an earlier age, particularly if they have long-standing diabetes — this study serves as a warning about the potential dangers of adding to that risk by using certain substances, especially in excess.
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Higher risk or premature and extremely premature disease
Published in the journal Heart, the study was designed to look at the role that substance use may play in increasing rates of atherosclerotic cardiovascular diseases (ASCVD) in younger adults. “Atherosclerotic” describes having fatty deposits on the inside of blood vessels — a major factor in the development of more severe forms of cardiovascular disease, including coronary artery disease (CAD).
Researchers looked at a database of health records from Veterans Affairs Healthcare to examine the relationship between self-reported substance use and premature ASCVD. This was defined as having an ASCVD event — like a heart attack or stroke — before age 55 for men, and before age 65 for women. Extremely premature ASCVD was defined as having an event before age 40.
Compared with people who developed non-premature ASCVD (after age 55 for men, or 65 for women), those who developed premature disease were more likely to use tobacco — 62.9% of participants, compared with 40.6%. They were also more likely to use alcohol (31.8% versus 14.8%), cocaine (12.9% versus 2.5%), amphetamine (2.9% versus 0.5%), and cannabis or marijuana (12.5% versus 2.7%). Once the researchers adjusted for other differences between the two groups, they still found a strikingly higher risk of premature ASCVD linked to several categories of substances: tobacco (97% higher), alcohol (50% higher), cocaine (144% higher), amphetamine (174% higher), cannabis (165% higher), and other drugs (153% higher).
Using more than one substance, not surprisingly, was found to increase the risk of premature ASCVD even more, and varied according to how many substances people used. The highest risk of premature ASCVD — about nine times the risk compared with no substance use — was seen in people who used four or more recreational substances. Similar trends were seen in the relationship between substance use and the risk for extremely premature ASCVD. In all categories, the risk of premature ASCVD based on substance use was slightly higher in women than in men.
Substance abuse and cardiovascular disease
This study provides compelling evidence that substance use is strongly linked to developing cardiovascular disease at an earlier age. But didn’t find that drug use directly caused this greater risk, strictly speaking, since it only looked at people who already used drugs or didn’t use them. It’s possibly that certain factors — like poorer health — might contribute both to a person’s substance use and to their risk of cardiovascular disease.
The researchers wrote that this study represents possibly “the most comprehensive pool of evidence” showing that “the penetration of all recreational substances was higher among patients with premature and extremely premature ASCVD.” For this reason, they noted, “the traditional practice of directing the majority of clinical focus towards optimization of traditional risk factors without equally addressing the use of recreational substances may result in a disservice to the young adult population.”
In other words, the commonplace practice of asking patients about tobacco or alcohol use, while important, may not be as important in many younger adults as finding out about other recreational and illicit drug use, and directing them toward treatment programs or other sources of help or information.
“With increasing use and legalization of recreational substances such as cannabis, it is essential for clinicians to recognize the penetration and associated cardiovascular risk of these substances among young adults,” the researchers continued. “Our findings also support the need for aggressive interventions in implementation and accessibility of drug cessation programs as another key element of the primary prevention of ASCVD.”
Want to learn more about protecting your heart? Read “Be Heart Smart: Know Your Numbers,” “Does Diabetes Hurt Your Heart?” “Fight Off Heart Disease With These Five Heart-Healthy Foods” and “Lower Your Risk of Heart Disease.”