Illicit drugs linked with serious heart rhythm disorder
>> Saturday, November 5, 2022
WELLNEWS
Victor
Dumaguing
SOPHIA, France -- Methamphetamines,
cocaine, opiates, and cannabis are associated with an increased likelihood of
developing atrial fibrillation, according to an 11-year study in more than 23
million adults published today in European Heart Journal, a journal
of the European Society of Cardiology (ESC).1
Risks of the heart rhythm disorder were elevated in illicit drug users regardless of established predisposing factors including age, obesity, tobacco use, alcohol abuse, heart disease, and diabetes.
“This was the first large, long-term study examining the relationship between methamphetamines, cocaine, opiates, cannabis and atrial fibrillation,” said study author Professor Gregory Marcus of the University of California, San Francisco, US. “All four drugs were associated with higher risks of developing atrial fibrillation than many conventional risk factors including high cholesterol and diabetes. This indicates that avoiding these substances could help prevent the condition.”
Atrial fibrillation is the most common heart rhythm disorder worldwide.2 Symptoms include palpitations, shortness of breath, fatigue, and difficulty sleeping. Atrial fibrillation increases the risk of stroke by five times. The condition is associated with a two-fold increased risk of death in women and a 1.5-fold increase in men. Alcohol and tobacco smoking have each been associated with a heightened risk of atrial fibrillation, but relationships with other drugs are poorly understood.
The study was conducted using databases of the Office of Statewide Health Planning and Development. The analysis included all adults in California who were free of atrial fibrillation and received care in an emergency department, same-day surgery unit, or hospital from 1 January 2005 to 31 December 2015.
The study included 23,561,884 participants. Of those, 98,271 used methamphetamine, 48,700 used cocaine, 10,032 used opiates, and 132,834 used cannabis. A total of 998,747 participants (4.2%) developed incident atrial fibrillation during the 11-year study.
The researchers analyzed associations between the use of each substance and a new diagnosis of atrial fibrillation after adjusting for factors that could influence the relationship, including age, sex, obesity, tobacco use, alcohol abuse, income, high blood pressure, dyslipidemias, diabetes, and coronary artery disease. The use of methamphetamines was associated with a nearly doubled risk of incident atrial fibrillation, with a hazard ratio of 1.86. The corresponding hazard ratios for opiates, cocaine, and cannabis were 1.74, 1.61, and 1.35, respectively.
Professor Marcus said: “Although the link was weakest for cannabis, it was still associated with a higher likelihood of a new atrial fibrillation diagnosis than known risk factors such as dyslipidemia and diabetes, which had hazard ratios of 1.26 and 1.24, respectively. Cannabis use carried a similar relative risk of incident atrial fibrillation as tobacco use, which had a hazard ratio of 1.32.”
The researchers also investigated the impact of the number of drugs and frequency of use. Participants using two or more illicit drugs were 1.63 times more likely to develop atrial fibrillation than single drug users. Regarding frequency, drug dependent participants had a similar risk of atrial fibrillation as episodic users.
Professor Marcus said: “In an analysis of unprecedented size, we have shown that users of illicit drugs were at substantially greater risks of atrial fibrillation compared with non-users. More than 60% of atrial fibrillation patients have significantly impaired quality of life, and strokes related to the condition are often fatal or disabling.2 As some regions take steps towards legalizing recreational cannabis and adopting more lenient laws on the use of other illicit drugs, our research suggests caution and the importance of disseminating information on the potential harms , not only on the addicting properties of these substances but also on their more serious life-threatening effects.
Next Week: A Closer Look at Anti-Cholesterol Medicines
Risks of the heart rhythm disorder were elevated in illicit drug users regardless of established predisposing factors including age, obesity, tobacco use, alcohol abuse, heart disease, and diabetes.
“This was the first large, long-term study examining the relationship between methamphetamines, cocaine, opiates, cannabis and atrial fibrillation,” said study author Professor Gregory Marcus of the University of California, San Francisco, US. “All four drugs were associated with higher risks of developing atrial fibrillation than many conventional risk factors including high cholesterol and diabetes. This indicates that avoiding these substances could help prevent the condition.”
Atrial fibrillation is the most common heart rhythm disorder worldwide.2 Symptoms include palpitations, shortness of breath, fatigue, and difficulty sleeping. Atrial fibrillation increases the risk of stroke by five times. The condition is associated with a two-fold increased risk of death in women and a 1.5-fold increase in men. Alcohol and tobacco smoking have each been associated with a heightened risk of atrial fibrillation, but relationships with other drugs are poorly understood.
The study was conducted using databases of the Office of Statewide Health Planning and Development. The analysis included all adults in California who were free of atrial fibrillation and received care in an emergency department, same-day surgery unit, or hospital from 1 January 2005 to 31 December 2015.
The study included 23,561,884 participants. Of those, 98,271 used methamphetamine, 48,700 used cocaine, 10,032 used opiates, and 132,834 used cannabis. A total of 998,747 participants (4.2%) developed incident atrial fibrillation during the 11-year study.
The researchers analyzed associations between the use of each substance and a new diagnosis of atrial fibrillation after adjusting for factors that could influence the relationship, including age, sex, obesity, tobacco use, alcohol abuse, income, high blood pressure, dyslipidemias, diabetes, and coronary artery disease. The use of methamphetamines was associated with a nearly doubled risk of incident atrial fibrillation, with a hazard ratio of 1.86. The corresponding hazard ratios for opiates, cocaine, and cannabis were 1.74, 1.61, and 1.35, respectively.
Professor Marcus said: “Although the link was weakest for cannabis, it was still associated with a higher likelihood of a new atrial fibrillation diagnosis than known risk factors such as dyslipidemia and diabetes, which had hazard ratios of 1.26 and 1.24, respectively. Cannabis use carried a similar relative risk of incident atrial fibrillation as tobacco use, which had a hazard ratio of 1.32.”
The researchers also investigated the impact of the number of drugs and frequency of use. Participants using two or more illicit drugs were 1.63 times more likely to develop atrial fibrillation than single drug users. Regarding frequency, drug dependent participants had a similar risk of atrial fibrillation as episodic users.
Professor Marcus said: “In an analysis of unprecedented size, we have shown that users of illicit drugs were at substantially greater risks of atrial fibrillation compared with non-users. More than 60% of atrial fibrillation patients have significantly impaired quality of life, and strokes related to the condition are often fatal or disabling.2 As some regions take steps towards legalizing recreational cannabis and adopting more lenient laws on the use of other illicit drugs, our research suggests caution and the importance of disseminating information on the potential harms , not only on the addicting properties of these substances but also on their more serious life-threatening effects.
Next Week: A Closer Look at Anti-Cholesterol Medicines
Cardiovascular protection from statins outweighs risk of muscle symptoms
Victor
Dumaguing
BARCELONA, Spain -- The known benefits of statin therapy in preventing cardiovascular disease, including heart attacks and strokes, outweigh the slightly increased risk of muscle symptoms, according to late breaking research presented in a Hot Line session at ESC Congress 2022.
Principal investigator Professor Colin Baigent, Director of the Medical Research Council Population Health Research Unit at the University of Oxford, UK said: “For most people taking a statin, any muscle-related symptoms they experience are not likely to be caused by the drug. The known protective effects of statins against cardiovascular disease greatly exceed the slightly increased risk of muscle symptoms. For example, for every 1,000 people taking a moderate intensity statin, the treatment would cause 11 generally mild episodes of muscle pain or weakness in the first year with no significant excess in subsequent years. Over a five year period, statins typically prevent 50 major vascular events in those with pre-existing vascular disease, and 25 major vascular events in those with no pre-existing vascular disease, with longer treatment yielding larger benefits.”
Statin therapy is effective for the prevention of cardiovascular disease, the world’s largest killer, and is widely prescribed. However, there have been concerns that statins may cause muscle pain or weakness, leading some patients to stop taking their treatment. This analysis was conducted to resolve uncertainties around the possible effects of statins on muscle symptoms.
This was an individual participant data meta-analysis of all recorded muscle symptoms in large-scale randomized blinded double-blind trials of statin therapy, led by researchers from Oxford Population Health. The researchers compiled data from 23 trials from the Cholesterol Treatment Trialists’ (CTT) Collaboration, with information on nearly 155,000 patients. All trials included at least 1,000 patients and at least two years of scheduled treatment. Adverse event data were collected for all individual participants in 19 large randomized double-blind trials of statin therapy versus placebo (123,940 patients) and in four randomized double-blind trials of more intensive versus less intensive statin therapy (30,724 patients).
The researchers examined all data on adverse effects reported by patients taking part in the clinical trials, as well as data on the timing of and reasons for stopping study treatment, use of other (non-trial) medications, other health conditions, and laboratory results that would help in the interpretation of particular adverse events.
In the 19 trials of any statin regimen versus placebo, during a median follow up of 4.3 years, 16,835 patients (27.1%) in the statin group and 16,446 (26.6%) in the placebo group reported muscle pain or weakness (rate ratio [RR] 1.03; 95% confidence interval [CI] 1.01–1.06). In the first year there was a 7% relative increase in reports of muscle pain or weakness among those allocated to a statin (RR 1.07; 95% CI 1.04–1.10), which corresponded to an absolute excess rate of 11 (95% CI 6–16)
Reports per 1,000 person years; in the remaining follow up period there was no evidence of any excess risk (RR 0.99; 95% CI 0.96–1.02). During the first year only about 1 in 15 reported cases of muscle pain or weakness were attributable to statin therapy.
In the four trials of more intensive versus less intensive statin therapy, high intensity regimens (e.g. atorvastatin 40 to 80 mg daily or rosuvastatin 20 to 40 mg daily) resulted in a larger relative increase in the rate of muscle pain or weakness than moderate intensity regimens, with rate ratios of 1.08 (95% CI 1.04–1.13) and 1.02 (95% CI 1.00–1.05), respectively.
Professor Baigent said: “Muscle symptoms such as pain or weakness were experienced by similar numbers of people in the statin and placebo groups. Statins were not the cause of muscle pain in more than 93% of patients who reported symptoms. Statin therapy marginally increased the frequency, but not the severity, of muscle-related symptoms. The small excess risk of muscle symptoms occurred principally during the first year after commencing therapy.”
He concluded: “The results should help doctors and patients to make informed decisions about whether to start or remain on statin therapy. Information provided to doctors and patients should be reviewed in light of our findings, including drug labelling and guidelines
Statins or vastatins are the first line of treatment for high cholesterol levels by inhibiting the action of HMG Co-A reductase, a key enzyme in the production of cholesterol in the liver. Our dear patients who have or had elevated cholesterol in the blood may have already received different mg of statins depending on their metabolic profiles of the following; simvastatin, atorvastatin, rosuvastatin to name a few.
BARCELONA, Spain -- The known benefits of statin therapy in preventing cardiovascular disease, including heart attacks and strokes, outweigh the slightly increased risk of muscle symptoms, according to late breaking research presented in a Hot Line session at ESC Congress 2022.
Principal investigator Professor Colin Baigent, Director of the Medical Research Council Population Health Research Unit at the University of Oxford, UK said: “For most people taking a statin, any muscle-related symptoms they experience are not likely to be caused by the drug. The known protective effects of statins against cardiovascular disease greatly exceed the slightly increased risk of muscle symptoms. For example, for every 1,000 people taking a moderate intensity statin, the treatment would cause 11 generally mild episodes of muscle pain or weakness in the first year with no significant excess in subsequent years. Over a five year period, statins typically prevent 50 major vascular events in those with pre-existing vascular disease, and 25 major vascular events in those with no pre-existing vascular disease, with longer treatment yielding larger benefits.”
Statin therapy is effective for the prevention of cardiovascular disease, the world’s largest killer, and is widely prescribed. However, there have been concerns that statins may cause muscle pain or weakness, leading some patients to stop taking their treatment. This analysis was conducted to resolve uncertainties around the possible effects of statins on muscle symptoms.
This was an individual participant data meta-analysis of all recorded muscle symptoms in large-scale randomized blinded double-blind trials of statin therapy, led by researchers from Oxford Population Health. The researchers compiled data from 23 trials from the Cholesterol Treatment Trialists’ (CTT) Collaboration, with information on nearly 155,000 patients. All trials included at least 1,000 patients and at least two years of scheduled treatment. Adverse event data were collected for all individual participants in 19 large randomized double-blind trials of statin therapy versus placebo (123,940 patients) and in four randomized double-blind trials of more intensive versus less intensive statin therapy (30,724 patients).
The researchers examined all data on adverse effects reported by patients taking part in the clinical trials, as well as data on the timing of and reasons for stopping study treatment, use of other (non-trial) medications, other health conditions, and laboratory results that would help in the interpretation of particular adverse events.
In the 19 trials of any statin regimen versus placebo, during a median follow up of 4.3 years, 16,835 patients (27.1%) in the statin group and 16,446 (26.6%) in the placebo group reported muscle pain or weakness (rate ratio [RR] 1.03; 95% confidence interval [CI] 1.01–1.06). In the first year there was a 7% relative increase in reports of muscle pain or weakness among those allocated to a statin (RR 1.07; 95% CI 1.04–1.10), which corresponded to an absolute excess rate of 11 (95% CI 6–16)
Reports per 1,000 person years; in the remaining follow up period there was no evidence of any excess risk (RR 0.99; 95% CI 0.96–1.02). During the first year only about 1 in 15 reported cases of muscle pain or weakness were attributable to statin therapy.
In the four trials of more intensive versus less intensive statin therapy, high intensity regimens (e.g. atorvastatin 40 to 80 mg daily or rosuvastatin 20 to 40 mg daily) resulted in a larger relative increase in the rate of muscle pain or weakness than moderate intensity regimens, with rate ratios of 1.08 (95% CI 1.04–1.13) and 1.02 (95% CI 1.00–1.05), respectively.
Professor Baigent said: “Muscle symptoms such as pain or weakness were experienced by similar numbers of people in the statin and placebo groups. Statins were not the cause of muscle pain in more than 93% of patients who reported symptoms. Statin therapy marginally increased the frequency, but not the severity, of muscle-related symptoms. The small excess risk of muscle symptoms occurred principally during the first year after commencing therapy.”
He concluded: “The results should help doctors and patients to make informed decisions about whether to start or remain on statin therapy. Information provided to doctors and patients should be reviewed in light of our findings, including drug labelling and guidelines
Statins or vastatins are the first line of treatment for high cholesterol levels by inhibiting the action of HMG Co-A reductase, a key enzyme in the production of cholesterol in the liver. Our dear patients who have or had elevated cholesterol in the blood may have already received different mg of statins depending on their metabolic profiles of the following; simvastatin, atorvastatin, rosuvastatin to name a few.
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