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Suen LW, Vittinghoff E, Wu AHB, Ravi A, Coffin PO, Hsue P, Lynch KL, Kazi DS, Riley ED. Multiple substance use and blood pressure in women experiencing homelessness. Addict Behav Rep 2023; 17:100483. [PMID: 36875801 PMCID: PMC9975611 DOI: 10.1016/j.abrep.2023.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/15/2022] [Accepted: 02/12/2023] [Indexed: 02/15/2023] Open
Abstract
Background Substance use increases risk of cardiovascular events, particularly among women with additional risk factors like housing instability. While multiple substance use is common among unstably housed individuals, relationships between multiple substance use and cardiovascular risk factors like blood pressure are not well characterized. Methods We conducted a cohort study between 2016 and 2019 to examine associations between multiple substance use and blood pressure in women experiencing homelessness and unstable housing. Participants completed six monthly visits including vital sign assessment, interview, and blood draw to assess toxicology-confirmed substance use (e.g., cocaine, alcohol, opioids) and cardiovascular health. We used linear mixed models to evaluate the outcomes of systolic and diastolic blood pressure (SBP; DBP). Results Mean age was 51.6 years; 74 % were women of color. Prevalence of any substance use was 85 %; 63 % of participants used at least two substances at baseline. Adjusting for race, body mass index and cholesterol, cocaine was the only substance significantly associated with SBP (4.71 mmHg higher; 95 % CI 1.68, 7.74) and DBP (2.83 mmHg higher; 95 % CI 0.72, 4.94). Further analysis found no differences in SBP or DBP between those with concurrent use of other stimulants, depressants, or both with cocaine, compared to those who used cocaine only. Conclusions Cocaine was the only substance associated with higher SBP and DBP, even after accounting for simultaneous use of other substances. Along with interventions to address cocaine use, stimulant use screening during cardiovascular risk assessment and intensive blood pressure management may improve cardiovascular outcomes among women experiencing housing instability.
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Affiliation(s)
- Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Akshay Ravi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Phillip O Coffin
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Department of Public Health, San Francisco, CA, United States
| | - Priscilla Hsue
- Division of Cardiology, Chan Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Elise D Riley
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Zhu Z, Vanderschelden B, Lee SJ, Blackwill H, Shafie M, Soun JE, Chow D, Chang P, Stradling D, Qian T, Yu W. Methamphetamine use increases the risk of cerebral small vessel disease in young patients with acute ischemic stroke. Sci Rep 2023; 13:8494. [PMID: 37231082 DOI: 10.1038/s41598-023-35788-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/24/2023] [Indexed: 05/27/2023] Open
Abstract
Methamphetamine use causes spikes in blood pressure. Chronic hypertension is a major risk factor for cerebral small vessel disease (cSVD). The aim of this study is to investigate whether methamphetamine use increases the risk of cSVD. Consecutive patients with acute ischemic stroke at our medical center were screened for methamphetamine use and evidence of cSVD on MRI of the brain. Methamphetamine use was identified by self-reported history and/or positive urine drug screen. Propensity score matching was used to select non-methamphetamine controls. Sensitivity analysis was performed to assess the effect of methamphetamine use on cSVD. Among 1369 eligible patients, 61 (4.5%) were identified to have a history of methamphetamine use and/or positive urine drug screen. Compared with the non-methamphetamine group (n = 1306), the patients with methamphetamine abuse were significantly younger (54.5 ± 9.7 vs. 70.5 ± 12.4, p < 0.001), male (78.7% vs. 54.0%, p < 0.001) and White (78.7% vs. 50.4%, p < 0.001). Sensitivity analysis showed that methamphetamine use was associated with increased white matter hyperintensities, lacunes, and total burden of cSVD. The association was independent of age, sex, concomitant cocaine use, hyperlipidemia, acute hypertension, and stroke severity. Our findings suggest that methamphetamine use increases the risk of cSVD in young patients with acute ischemic stroke.
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Affiliation(s)
- Zhu Zhu
- Department of Neurology, University of California Irvine, 200 S. Manchester Ave. Suite 206, Orange, CA, 92868, USA
| | - Benjamin Vanderschelden
- Department of Neurology, University of California Irvine, 200 S. Manchester Ave. Suite 206, Orange, CA, 92868, USA
| | - Sook Joung Lee
- Department of Neurology, University of California Irvine, 200 S. Manchester Ave. Suite 206, Orange, CA, 92868, USA
- Department of Physical Medicine and Rehabilitation, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Haley Blackwill
- Department of Neurology, University of California Irvine, 200 S. Manchester Ave. Suite 206, Orange, CA, 92868, USA
| | - Mohammad Shafie
- Department of Neurology, University of California Irvine, 200 S. Manchester Ave. Suite 206, Orange, CA, 92868, USA
| | - Jennifer E Soun
- Department of Radiological Science, University of California, Irvine, CA, USA
| | - Daniel Chow
- Department of Radiological Science, University of California, Irvine, CA, USA
| | - Peter Chang
- Department of Radiological Science, University of California, Irvine, CA, USA
| | - Dana Stradling
- Department of Neurology, University of California Irvine, 200 S. Manchester Ave. Suite 206, Orange, CA, 92868, USA
| | - Tianchen Qian
- Department of Statistics, University of California, Irvine, CA, USA
| | - Wengui Yu
- Department of Neurology, University of California Irvine, 200 S. Manchester Ave. Suite 206, Orange, CA, 92868, USA.
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Riley ED, Hsue PY, Coffin PO. A Chronic Condition Disguised as an Acute Event: the Case for Re-thinking Stimulant Overdose Death. J Gen Intern Med 2022; 37:3462-3464. [PMID: 35713806 PMCID: PMC9550944 DOI: 10.1007/s11606-022-07692-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
Recent reports indicate that stimulant-related deaths are increasing dramatically. People who die from acute stimulant toxicity have high rates of pre-existing cardiovascular disease (CVD), much of which is undiagnosed. Moreover, people who use stimulants with CVD often remain asymptomatic until presenting to an emergency department with an acute event. Prior research shows that symptoms of stimulant toxicity may occur on a regular basis, and that people who die from stimulant toxicity are older than those who die of opioid toxicity. Taken collectively, the existing evidence suggests that death from acute stimulant toxicity is often an outcome of long-term, cumulative exposure leading to cardiovascular dysfunction rather than acute intoxication. Strategies tailored to the distinct etiology of stimulant overdose are needed. We propose a three-part approach including (1) implementing stimulant use interventions that promote not only abstinence, but also use reduction, (2) treating ongoing stimulant use as a chronic cardiovascular condition, and (3) making stimulant toxicity interventions relevant to the populations most affected, which includes people outside of the traditional health-care system. In short, to reduce stimulant-related fatality, we need to transform our approach in ways that are tailored to address its natural history.
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Affiliation(s)
- Elise D Riley
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, School of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA.
| | - Priscilla Y Hsue
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Phillip O Coffin
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, School of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco, CA, 94143-0874, USA
- San Francisco Department of Public Health, San Francisco, CA, USA
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