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Herbal amphetamine increased risk for death in ACS patients
Ali WM. Circulation. 2011;doi:10.1161/CIRCULATIONAHA.111.039768.
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Chewing khat, a natural, plant-derived stimulant with effects similar to amphetamine, appears to be associated with worse in-hospital outcomes for patients with acute coronary syndrome compared with patients who do not chew khat.
In the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2) study, 19% of 7,399 patients with ACS enrolled reported chewing khat. When researchers compared ACS patients who chewed khat with patients who did not, they found that khat users had a 7.5% in-hospital death rate from CVD vs. 3.8% for non-khat users. At 1 month, the death rate was 15.5% for khat users and 6.4% for non-khat users (P<.001). At 1 year, the death rate increased to 18.8% for khat users and 10.8% for non-khat users (P<.001). Death rates were consistently higher among khat users up to the age of 80 years, but khat chewing occurs across the spectrum of ages.
Khat chewers were also more likely to have higher heart rate and STEMI. In addition, rates of recurrent myocardial ischemia, cardiogenic shock, ventricular arrhythmia and stroke elevated in khat chewers as compared with non-khat users. When researchers adjusted for baseline variability, they found that khat chewing was an independent risk factor for death and for recurrent ischemia, HF and stroke.
Men were more likely to chew khat vs. women, who only accounted for 14% of khat chewers in this study. However, women were as likely as men to experience adverse CV effects as a result of this habit. Khat chewers of both sexes had lower CV risk factors, including diabetes, hypertension and dyslipidemia. However, men who chew khat were more likely to develop stroke, particularly hemorrhagic stroke, compared with nonusers. The increased risk for stroke was not significant among women who chew khat.
The First Gulf Registry of Acute Coronary Events (Gulf RACE-1) showed that khat chewing was associated with increased in-hospital stroke and death in patients with ACS compared with non-khat chewers.
It is estimated that 20 million people worldwide use khat, which was previously confined to East Africa and the Arabian Peninsula. “In England, 7 metric tons of khat is estimated to travel through Heathrow Airport each week, originating from Yemen, Ethiopia and Kenya. Recently, in the United States, numerous seizures of graba, or dried khat, have been made. Moreover, fresh khat is believed to have been confiscated throughout the United States,” according to background information in the study.
Jassim Al Suwaidi, MB, ChB, consultant cardiologist and director of CV research at Hamad General Hospital, Doha, Qatar, said improved education about the CV risks of khat chewing is important.
“Global awareness of the negative impact of khat chewing on health and social life is warranted before it becomes endemic,” he said in a press release. “This report underscores the importance of improving education about the CV risks of khat chewing, as well as the need for further studies in the field.”
Disclosure: The researchers report no relevant financial disclosures.
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