The use of cannabis, cocaine, methamphetamine, and opiates is associated with an increased risk for incident atrial fibrillation (AF), according to the results of a longitudinal analysis published in the European Heart Journal.
Efforts have been under way over the last few years to understand the modifiable risk factors that might contribute to the incidence of AF, which, in turn, could have a broader impact on patient outcomes and health care spending. With AF regarded as a preventable illness, the search for modifiable risk factors thus remains ongoing.
The current study was conducted among California residents aged 18 years and older who had received care in a California emergency department, ambulatory surgery unit, or inpatient hospital between January 1, 2015 and December 31, 2015, in order to evaluate the association between the use of methamphetamine, cocaine, opiates, and cannabis and the development of incident AF.
All patients who qualified were identified via use of the Office of Statewide Health Planning and Development (OSHPD) California State Ambulatory Surgery Databases, Emergency Department Databases, and State Inpatient Databases. Up to 25 International Classification of Disease, Ninth Revision (ICD-9) and 21 Current Procedural Terminology (CPT) codes for each health care encounter were recorded.
Following the application of exclusion criteria, a total of 23,561,884 patients were identified who had experienced 111,120,439 encounters and were subsequently included in the analysis. Of these individuals,
- 98,271 used methamphetamine,
- 48,701 used cocaine,
- 10,032 used opiates, and
- 132,834 used cannabis.
Overall, 4.2% (998,747 of 23,561,884) of the total population developed incident AF over the 1-year study period.
After adjustments for age, sex, race/ethnicity, income, hypertension, dyslipidemia, diabetes, coronary artery disease (CAD), congestive heart failure, valvular heart disease, obstructive sleep apnea, chronic kidney disease (CKD), obesity, tobacco use, alcohol use, and the other 3 substances being evaluated in the study, participants with documented methamphetamine use had a substantially higher risk for development of AF compared with the rest of the population.
Following adjustments for the same covariates, methamphetamine use was associated with an increased incidence of AF (hazard ratio [HR], 1.86; 95% CI, 1.81-1.92) — the highest association reported among the 4 substances explored.
In contrast, after adjustments for the same variables and the other 3 substances being investigated, cocaine use was associated with a strong relative risk for AF (HR, 1.61; 95% CI, 1.55-1.68), which was of similar or greater magnitude to the associations reported between the other measured cardiovascular (CV) risk factors and AF.
Regarding the use of opiates, after adjusting for the same variables and the other 3 substances being assessed, the association between opiate use and incident AF (HR, 1.74; 95% CI, 1.62-1.87) exhibited point estimates that were of similar or greater magnitude to those measured by the CV risk factors of dyslipidemia, diabetes, obesity, tobacco use, and CAD.
With respect to cannabis use, after adjusting for the same variables and the other 3 substances being studied, individuals who used cannabis had a higher relative risk for developing AF compared with the rest of the population. However, this increase in risk was the lowest of the 4 substances evaluated (HR, 1.35; 95% CI, 1.30-1.40).
In spite of exhibiting a weaker association with incident AF compared with the other substances, cannabis use nonetheless exhibited an association of a similar or greater magnitude to risk factors such as dyslipidemia, diabetes, and CKD. Additionally, those who used cannabis exhibited a similar relative risk for incident AF as did those who used traditional tobacco (HR, 1.35; 95% CI, 1.30-1.40 vs HR, 1.32; 95% CI, 1.32-1.33, respectively).
Several limitations of the current study should be noted. Although the analyses of more than 23 million patients in OSHPD permitted an assessment of substance use and AF of unprecedented size and diversity, it relied on providers and administrators providing accurately documenting the ICD-9 codes for all patient encounters — a process that may be subject to human error. Further, such large administrative databases provided insight into patterns that might warrant additional study, to better understand the physiologic and mechanistic drivers of these associations.
“[O]ur work supports the continued medical and community efforts aimed at reducing substance abuse and shows that these efforts may have the potential to reduce long-term [CV] complications associated with AF,” the researchers concluded.
Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Lin AL, Nah G, Tang JJ, Vittinghoff E, Dewland TA, Marcus GM. Cannabis, cocaine, methamphetamine, and opiates increase the risk of incident atrial fibrillation. Eur Heart J. Published online October 18, 2022. doi:10.1093/eurheartj/ehac558