Alcohol, opioids most common causes of substance use-related heart disease deaths
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Key takeaways:
- Substance use-related CVD deaths rose on average 4% per year from 1999 to 2019.
- The most commonly cited substances were alcohol, opioids and stimulants.
Substance use-related CVD deaths increased at an average of 4% per year from 1999 to 2019, with alcohol and opioids the most common contributors, despite an overall reduction in CVD mortality in the U.S. during the same period, data show.
In a large database analysis of CDC death data published in the Journal of the American Heart Association, researchers also found that the increase in substance use-related CVD age-adjusted mortality rate has particularly accelerated since 2012.
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“Despite drops in overall CVD disease deaths from 1999 to 2019, CVD deaths in which substance use was cited as a contributing factor increased an average of 4% per year, with the death rate accelerating to 6.2% from 2012 through 2019,” Dmitry Abramov, MD, a cardiologist and associate professor of medicine at Loma Linda University Health in Redlands, California, told Healio. “Prominent increases in CVD deaths associated with substance use were most notable among women, American Indian or Alaskan individuals, younger individuals, rural area residents, and users of cannabis and psychostimulants. However, increases were seen across the board among all of the studied substances and among all studied demographics, which highlights the significant public health burden of substance use as a contributor to CVD death.”
Abramov and colleagues analyzed deaths occurring within the U.S. related to CVD and substance use (excluding smoking or tobacco use) from the CDC WONDER database. Researchers calculated crude, age-adjusted mortality rates per 100,000 population, annual percent change, and average annual percent changes from 1999 to 2019.
From 1999 to 2019, there were 51,998,560 deaths in the U.S., of which 29,455,193 deaths were related to CVD in people aged 25 years and older. Of those deaths, 2.2% listed substance use as a concomitant cause of death.
Of the deaths attributed to substance use and CVD, 75.6% were men; 70.6% were white and 65% were related to alcohol use.
Researchers found that the age-adjusted mortality rates per 100,000 population were more pronounced among men (22.5; 95% CI, 22.5-22.6) than women, more pronounced among American Indian or Alaska Native people (37.7; 95% CI, 37-38.4) than other races or ethnicities and more pronounced among those living in rural areas (15.2; 95% CI, 15.1-15.3) than those living in urban areas.
Assessing substance use category, age-adjusted mortality rate per 100,000 population was highest for alcohol-related CVD death (9.09; 95% CI, 9.07-9.12), followed by opioids (2.04; 95% CI, 2.03-2.06), cocaine (1.45; 95% CI, 1.44-1.46) and stimulants (0.95; 95% CI, 0.94-0.96).
The overall substance use-related CVD age-adjusted mortality rates increased from 9.9 (95% CI, 9.8-10.1) in 1999 to 21.4 (95% CI, 21.2-21.6) in 2019, with an average annual percent change of 4% (95% CI, 3.7-4.3).
The increases in substance use-related CVD average annual percent change were greatest among women (4.8%; 95% CI, 4.5-5.1), American Indian or Alaska Native people (5.4%; 95% CI, 4.4-6.4), younger adults aged 25 to 39 years (5.3%; 95% CI, 3.9-6.6), those living in rural areas (5%; 95% CI, 4.6-5.4) and people who used cannabis and psychostimulants (12.7%; 95% CI, 10.9-14.5).
“Rising rates of CVD mortality associated with substance use should lead to additional public health efforts to support comprehensive evaluation and management of substance use in the U.S.,” Abramov told Healio. “That includes clinician and patient education, as well as attention to socioeconomic factors that contribute to substance use. Additional public health efforts are important to both reduce substance use and to reverse the trends in CVD deaths associated with substance use and will hopefully lead to further reduction in the overall burden of CVD.”
For more information:
Dmitry Abramov, MD, can be reached at dabramov@llu.edu; X (Twitter): @dmitryabramovmd.
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