Substance use common in premature ASCVD
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Among veterans, recreational substance use was associated with a higher probability of premature and extremely premature atherosclerotic CVD, and the link was strongest in women, researchers reported in Heart.
Even with an upsurge in the frequency of ASCVD among young adults, the attributable risk of recreational substance use in this population has been incompletely evaluated, so the association of all recreational substances with premature and extremely premature ASCVD needed to be assessed, the researchers wrote.
Using the nationwide Veterans Affairs Healthcare System administrative and clinical data sets, Dhruv Mahtta, DO, MBA, cardiology fellow at Baylor College of Medicine, and colleagues identified veterans with a diagnosis of ASCVD aged at least 18 years.
Researchers included 1,248,158 patients with ASCVD, 135,703 of whom had premature ASCVD, receiving primary care services throughout the VA Healthcare System from October 2014 to September 2015, using the most recent primary care visit from that period as the baseline.
According to the researchers, ASCVD was defined as a history of ischemic heart disease, ischemic cerebrovascular disease or peripheral artery disease.
Compared with patients with non-premature ASCVD, patients with premature ASCVD were more likely to be women (13.9% vs. 0.7%), to be nonwhite (33.1% vs. 19.8%), to have obesity (55.8% vs. 39.9%) and to have hypercholesterolemia (47.4% vs. 29.4%; P < .01 for all comparisons). The mean Diagnostic Cost Group relative risk score was higher among patients with premature ASCVD (2.18 vs. 1.54; P < .01).
Compared with veterans with non-premature ASCVD, those with premature ASCVD were more likely to use tobacco (62.9% vs. 40.6%; adjusted OR = 1.97; 95% CI, 1.94-2), alcohol (31.8% vs. 14.8%; aOR = 1.5; 95% CI, 1.47-1.52), cocaine (12.9% vs. 2.5%; aOR = 2.44; 95% CI, 2.38-2.5), amphetamines (2.9% vs. 0.5%; aOR = 2.74; 95% CI, 2.62-2.87) and cannabis (12.5% vs. 2.7; aOR = 2.65; 95% CI, 2.59-2.71). The researchers also noted that use of other drugs was more likely in those with premature ASCVD compared with non-premature ASCVD (aOR = 2.53; 95% CI, 2.47-2.59).
The connection between premature ASCVD and substance use was strongest in those who used at least four substances, and was stronger in women than in men, Mahtta and colleagues wrote.
“Apart from optimization of metabolic risk factors, young adults and especially women with premature ASCVD should be screened thoroughly for the use of recreational substances, appropriately risk-stratified and directed towards multidisciplinary pathways (pharmacological and nonpharmacological) to achieve and maintain cessation,” the researchers wrote.
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