Cocaine and Marijuana Use Among Young Adults With Myocardial Infarction.
Cocaine and Marijuana Use Among Young Adults With Myocardial Infarction.
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可卡因和大麻在具有心肌梗塞的年轻人中使用。
DOI：
10.1016/j.jacc.2018.02.047
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发表时间：
2018-06-05
影响因子：
24
通讯作者：
Blankstein R
中科院分区：
文献类型：
--
作者：
DeFilippis EM;Singh A;Divakaran S;Gupta A;Collins BL;Biery D;Qamar A;Fatima A;Ramsis M;Pipilas D;Rajabi R;Eng M;Hainer J;Klein J;Januzzi JL;Nasir K;Di Carli MF;Bhatt DL;Blankstein R
药物滥用在年轻人中越来越普遍，但心血管结果的数据仍然有限。本研究的目的是评估 50 岁以内首次发生心肌梗塞 (MI) 的成年人吸食可卡因和大麻的流行率，并确定其与长期结果的关系。该研究回顾性分析了 2000 年至 2016 年间在两家学术医院就诊的 50 岁以下 1 型 MI 患者的记录。通过审查 MI 前一周内患者报告的药物滥用记录或毒理学筛查中的物质检测来确定药物滥用情况。社会保障管理局的死亡主档案确定了生命状况。死亡原因是通过电子健康记录和死亡证明来判定的。 Cox 模型是为了避免全因死亡和心血管死亡而进行的。共有 2,097 名 1 型 MI 患者（平均年龄 44.0 ± 5.1 岁，19.3% 女性，73% 白人），中位随访时间为 11.2 年（四分位距：7.3 至 14.2 年）。 224 名患者（10.7%）吸食可卡因和/或大麻； 99 名患者（4.7%）吸食可卡因，125 名患者吸食大麻（6.0%）。有药物滥用的个体患糖尿病（14.7% vs. 20.4%；p=0.05）和高脂血症（45.7% vs. 60.8%；p<0.001）的比率显着较低，但他们使用烟草的可能性明显更高（70.3% vs. 49.1%；p < 0.001）。调整基线协变量后，使用可卡因和/或大麻与显着较高的心血管死亡率（风险比：2.22；95% 置信区间：1.27 至 3.70；p = 0.005）和全因死亡率（风险比：1.99；95% 置信区间：1.35 至 2.97；p = 0.001）相关。 10% 年龄≤50 岁的心肌梗死患者使用可卡因和/或大麻，并且与较差的全因死亡率和心血管死亡率相关。这些发现强化了目前对患有心梗的年轻人进行药物使用筛查的建议，并强调需要进行咨询以预防未来的不良事件。
Substance abuse is increasingly prevalent among young adults, but data on cardiovascular outcomes remain limited. The objectives of this study were to assess the prevalence of cocaine and marijuana use in adults with their first myocardial infarction (MI) at ≤50 years and to determine its association with long-term outcomes. The study retrospectively analyzed records of patients presenting with a type 1 MI at ≤50 years at 2 academic hospitals from 2000 to 2016. Substance abuse was determined by review of records for either patient-reported substance abuse during the week before MI or substance detection on toxicology screen. Vital status was identified by the Social Security Administration’s Death Master File. Cause of death was adjudicated using electronic health records and death certificates. Cox modeling was performed for survival free from all-cause and cardiovascular death. A total of 2,097 patients had type 1 MI (mean age 44.0 ± 5.1 years, 19.3% female, 73% white), with median follow-up of 11.2 years (interquartile range: 7.3 to 14.2 years). Use of cocaine and/or marijuana was present in 224 (10.7%) patients; cocaine in 99 (4.7%) patients, and marijuana in 125 (6.0%). Individuals with substance use had significantly lower rates of diabetes (14.7% vs. 20.4%; p=0.05) and hyperlipidemia (45.7% vs. 60.8%; p<0.001), but they were significantly more likely to use tobacco (70.3% vs. 49.1%; p < 0.001). The use of cocaine and/or marijuana was associated with significantly higher cardiovascular mortality (hazard ratio: 2.22; 95% confidence interval: 1.27 to 3.70; p = 0.005) and all-cause mortality (hazard ratio: 1.99; 95% confidence interval: 1.35 to 2.97; p = 0.001) after adjusting for baseline covariates. Cocaine and/or marijuana use is present in 10% of patients with an MI at age ≤50 years and is associated with worse all-cause and cardiovascular mortality. These findings reinforce current recommendations for substance use screening among young adults with an MI, and they highlight the need for counseling to prevent future adverse events.
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