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Busceti CL, Bucci D, De Lucia M, Ferrucci M, Scioli M, Carrizzo A, Nicoletti F, Vecchione C, Fornai F. Different Doses of Methamphetamine Are Needed to Produce Locomotor or Blood Pressure Sensitization in Mice. Life (Basel) 2024; 14:723. [PMID: 38929706 PMCID: PMC11205198 DOI: 10.3390/life14060723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Methamphetamine (METH) exposure increases locomotor sensitization. However, no study has explored the occurrence of cardiovascular sensitization. The present study, carried out in mice, analyzed the following: (i) METH sensitization extending to systolic blood pressure (SBP); (ii) a potential correlation between ambulatory and cardiovascular sensitization; and (iii) morphological alterations within meso-striatal, meso-limbic and pontine catecholamine systems including c-fos expression. Locomotor activity, SBP and occurrence of morphological alterations of catecholaminergic neurons were assessed in C57Bl/6J mice following daily i.p. injections of either saline or METH (1, 2 or 5 mg/kg) for 5 consecutive days and following 6 days of withdrawal. Reiterated exposure to the lower doses of METH (1 mg/kg and 2 mg/kg) produced in mice locomotor sensitization without altering SBP. In contrast, repeated treatment with the highest dose of METH (5 mg/kg) produced sensitization of SBP in the absence of locomotor sensitization. No morphological alterations but increases in c-fos expression within neurons of locus coeruleus and nucleus accumbens were detected. The present data suggest that METH produces plastic changes that extend beyond the motor systems to alter autonomic regulation. This cardiovascular sensitization occurs independently of locomotor sensitization. The persistency of increased blood pressure may underlie specific mechanisms operating in producing hypertension.
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Affiliation(s)
- Carla Letizia Busceti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, 86077 Pozzilli, Italy; (D.B.); (M.D.L.); (M.S.); (A.C.); (F.N.); (C.V.)
| | - Domenico Bucci
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, 86077 Pozzilli, Italy; (D.B.); (M.D.L.); (M.S.); (A.C.); (F.N.); (C.V.)
| | - Massimiliano De Lucia
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, 86077 Pozzilli, Italy; (D.B.); (M.D.L.); (M.S.); (A.C.); (F.N.); (C.V.)
| | - Michela Ferrucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Mariarosaria Scioli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, 86077 Pozzilli, Italy; (D.B.); (M.D.L.); (M.S.); (A.C.); (F.N.); (C.V.)
| | - Albino Carrizzo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, 86077 Pozzilli, Italy; (D.B.); (M.D.L.); (M.S.); (A.C.); (F.N.); (C.V.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
| | - Ferdinando Nicoletti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, 86077 Pozzilli, Italy; (D.B.); (M.D.L.); (M.S.); (A.C.); (F.N.); (C.V.)
- Department of Physiology and Pharmacology, University Sapienza, 00185 Roma, Italy
| | - Carmine Vecchione
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, 86077 Pozzilli, Italy; (D.B.); (M.D.L.); (M.S.); (A.C.); (F.N.); (C.V.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
| | - Francesco Fornai
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, 86077 Pozzilli, Italy; (D.B.); (M.D.L.); (M.S.); (A.C.); (F.N.); (C.V.)
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
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Åhman A, Karlsson A, Berge J, Håkansson A. Mortality, morbidity, and predictors of death among amphetamine-type stimulant users - a longitudinal, nationwide register study. Addict Behav Rep 2024; 19:100553. [PMID: 38800761 PMCID: PMC11127464 DOI: 10.1016/j.abrep.2024.100553] [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: 01/24/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Use of amphetamine-type stimulants (ATS) contributes substantially to the global burden of disease. Large-scale follow-up studies of morbidity and mortality in ATS users are few. This study analysed morbidity, mortality, and potential predictors of all-cause mortality in a nationwide cohort of patients with ATS use disorder. Methods Data was acquired from national Swedish registers. All Swedish residents 18 years or older, with a registered ATS use diagnosis in 2013-2014 were included (N = 5,018) and followed until December 31, 2017. Comorbid diagnoses and causes of death were assessed and potential predictors of all-cause mortality were examined through Cox regression. Results Median age at inclusion was 36.6 years (interquartile range 27.4---48.1) and 70.5 % were men. The crude mortality rate was 24.6 per 1,000 person-years. The adjusted all-cause standardized mortality ratio was 12.4 (95 % CI [11.34-13.55]). The most common cause of death was overdose (28.9 %). Multiple drug use (hazard ratio 1.39, 95 % CI [1.14-1.70], p = 0.004), anxiety (hazard ratio 1.39, 95 % CI [1.11-1.72], p = 0.014), viral hepatitis (hazard ratio 1.85, 95 % CI [1.50-2.29], p = 0.004), and liver disease (hazard ratio 2.41, 95 % CI [1.55-3.74], p = 0.004) were predictors of all-cause mortality. Conclusions Multiple drug use, anxiety disorders, viral hepatitis and liver diseases were identified as risk factors for death. Our findings call for better screening, prevention, and treatment of somatic and psychiatric comorbidity among ATS users to reduce mortality.
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Affiliation(s)
- A. Åhman
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
- Faculty of Medicine, Department of Clinical Sciences Lund, BMC F12, Sölvegatan 19, 221 84 Lund, Sweden
| | - A. Karlsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
- Faculty of Medicine, Department of Clinical Sciences Lund, BMC F12, Sölvegatan 19, 221 84 Lund, Sweden
| | - J. Berge
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
- Faculty of Medicine, Department of Clinical Sciences Lund, BMC F12, Sölvegatan 19, 221 84 Lund, Sweden
| | - A. Håkansson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
- Faculty of Medicine, Department of Clinical Sciences Lund, BMC F12, Sölvegatan 19, 221 84 Lund, Sweden
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Bayazit H, Baronia R, Wakefield SM. Methamphetamine intoxication and suicidal ideation/behavior in the emergency department. Curr Med Res Opin 2024; 40:849-854. [PMID: 38511972 DOI: 10.1080/03007995.2024.2333429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/18/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND This study investigates the association between Methamphetamine (MA) intoxication and suicidal ideation/behavior in patients presenting to emergency departments. Amidst rising MA use and co-use with opioids, this "twin epidemic" has manifested in increasing admissions for MA intoxication, often accompanied by psychiatric symptoms that can escalate to suicidal behaviors. METHOD This retrospective study utilized patient records and analyzed data from 629 patients admitted to a Texas emergency department in 2020, with MA intoxication confirmed via urine tests and patient interviews. The suicidal tendencies were assessed using the Columbia-Suicide Severity Scale. The 629 patients were divided into three groups for analysis: Group I (n = 188), MA positive with suicidal ideation (SI) (MA + SI+); Group II (n = 202), MA-positive without SI (MA + SI-); and Group III (n = 239), MA-negative with SI (MA- SI+). Multiple regression analysis was used to elicit clinical features predicting patients presenting to the emergency department with acute MA intoxication. RESULTS Results reveal that approximately half of patients with acute MA intoxication reported suicidal thoughts, indicating a significant association between MA use and suicidal tendencies. Females exhibited higher rates of suicidal thoughts, behavior, and subsequent medical attention compared to males. Sociodemographic characteristics and clinical features differed among MA-positive patients with and without SI. Multivariable regression analysis identified factors influencing MA use, including cannabis use, male gender, agitation, and an inverse association with alcohol use. Notably, the severity and potential lethality of suicidal behavior in MA-intoxicated patients paralleled those observed in psychiatric patients without MA use. CONCLUSION These results underscore the urgent need for targeted interventions to address the complex interplay between MA use and suicidal risks in the emergency department setting, as well as broader public health strategies to combat the increasing prevalence of MA use.
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Affiliation(s)
- Huseyin Bayazit
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
- Behavioral Sciences and Psychiatry Department, Duke University, Durham, NC, USA
| | - Regina Baronia
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
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Åhman A, Wingren CJ, Håkansson A. Causes and circumstances of death in stimulant and opioid use-A comparative study. PLoS One 2024; 19:e0297838. [PMID: 38324514 PMCID: PMC10849257 DOI: 10.1371/journal.pone.0297838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
AIMS To investigate the individual characteristics, causes and circumstances around deaths in stimulant use, and to examine how individuals who died with stimulants in their body differ from individuals who died with opioids in their body. METHODS This study includes individuals who died during the years 2000-2018 and underwent a forensic autopsy at Forensic Medicine in Lund, Skåne County, Sweden. All individuals over 18 years of age with stimulants (n = 310), opioids (n = 2,039) or both stimulants and opioids (n = 385) in the body at the time of death, were included. The three groups were assessed regarding gender, age, place of death, BMI, other substances detected in forensic toxicological analysis, organ weights and underlying and contributing causes of death. The data were analysed by frequency and proportion calculations, cross-tabulations and comparisons of medians. RESULTS The median age at death of the study population (n = 2,734) was 45.5 years (interquartile range ☯IQR] 32-60 years) and 73.2% were men. The most common cause of death in the stimulant group was suicide (26.8%), higher proportion compared to the opioid group (20.8%) (p = 0.017) and in the polysubstance group accidental poisoning (38.2%), higher proportion compared to the opioid group (18.0%) (p<0.001). Death by transport accidents was significantly associated with the stimulant group (p<0.001) as well as death by other accidents (p = 0.016). CONCLUSIONS Individuals who died with stimulants in their body died at a higher rate from suicide, transport accidents and other accidents, compared to individuals who died with opioids in their body. This study indicates the need to identify and prevent psychiatric conditions, elevated suicide risk, and risk-taking behaviors among people who use stimulants.
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Affiliation(s)
- Ada Åhman
- Department of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden
| | - Carl Johan Wingren
- Unit for Forensic Medicine, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden
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Cui X, Gao B, Yu Y, Gu Y, Hu L. Chronic Administration of Methamphetamine Aggravates Atherosclerotic Vulnerable Plaques in Apolipoprotein E Knockout Mice Fed with a High-cholesterol Diet. Curr Mol Med 2024; 24:495-504. [PMID: 36944618 DOI: 10.2174/1566524023666230321095233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND It has been observed previously that chronic methamphetamine (METH) administration could upregulate neuropeptide Y (NPY) expression and promote atherosclerotic formation in apolipoprotein E knockout (ApoE-/-) mice fed with a normal cholesterol or high diet and NPY might be involved in the pathogenesis of METHinduced atherogenic effects through NPY Y1 receptor pathway. Vulnerable coronary atherosclerotic plaque (VP) is a critical pathological finding responsible for the acute coronary syndrome (ACS). In this study, we explored whether METH abuse could aggravate the formation of VP in ApoE-/- mice fed with high cholesterol diet. OBJECTIVE The purpose of this study was to observe if chronic METH administration could aggravate vulnerable plaque (VP) formation in ApoE-/- mice fed with a highcholesterol diet. METHODS Male ApoE-/- mice fed with a high-cholesterol diet were intraperitoneally injected with normal saline (NS) or 8 mg/kg/day METH (M8) for 24 weeks. Body weight was monitored from baseline to 24 weeks at 2 weeks intervals. After 24 weeks of treatment, plasma lipid variables were measured. Movat's staining and immunohistochemical staining were performed on frozen sections of the aortic roots to calculate VP percentage and intraplaque hemorrhage (IPH) percentage and detect expression of NPY, vascular endothelial growth factor (VEGF), and CD31. In vitro, the expressions of Y2R, VEGF, and CD31 were detected by immunofluorescence staining in aortic endothelial cells incubated with PBS, 100μM METH, 10nmol NPY, or 100μM METH plus 10nmol NPY for 12 hours. RESULTS The CD31 positive area, percentage of IPH, VP, and the expressions of NPY and VEGF were significantly increased in the M8 group than in the NS group. In vitro, the expressions of Y2R, VEGF, and CD31 were significantly increased in the METH+NPY group than in the PBS, METH, and NPY groups and these effects could be blunted by treatment with a Y2R antagonist or DPPIV inhibitor. CONCLUSION Chronic METH administration could aggravate VP in ApoE-/- mice fed with a high-cholesterol diet, possibly through upregulating vascular NPY and VEGF expression and promoting angiogenesis and vessel rupture in atherosclerotic plaques. Our findings indicated that increased VP formation might contribute to the development of acute coronary syndrome post-chronic METH abuse by activating DPPIV/NPY/Y2R pathway.
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MESH Headings
- Animals
- Plaque, Atherosclerotic/metabolism
- Plaque, Atherosclerotic/pathology
- Plaque, Atherosclerotic/etiology
- Methamphetamine/adverse effects
- Methamphetamine/administration & dosage
- Methamphetamine/pharmacology
- Mice
- Male
- Apolipoproteins E/genetics
- Apolipoproteins E/metabolism
- Mice, Knockout
- Diet, High-Fat/adverse effects
- Atherosclerosis/metabolism
- Atherosclerosis/pathology
- Atherosclerosis/etiology
- Atherosclerosis/chemically induced
- Atherosclerosis/genetics
- Cholesterol, Dietary/adverse effects
- Cholesterol, Dietary/administration & dosage
- Vascular Endothelial Growth Factor A/metabolism
- Vascular Endothelial Growth Factor A/genetics
- Mice, Knockout, ApoE
- Disease Models, Animal
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Affiliation(s)
- Xiaoxue Cui
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Wuhan, Hubei, China
| | - Bo Gao
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Wuhan, Hubei, China
| | - Yijun Yu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Wuhan, Hubei, China
| | - Ye Gu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Wuhan, Hubei, China
| | - Liqun Hu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Wuhan, Hubei, China
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Wagner KD, Marks C, Fiuty P, Harding RW, Page K. A qualitative study of interest in and preferences for potential medications to treat methamphetamine use disorder. Addict Sci Clin Pract 2023; 18:47. [PMID: 37587515 PMCID: PMC10433563 DOI: 10.1186/s13722-023-00401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION We examined acceptability of and preferences for potential medications for treating methamphetamine use disorder (MUD) among people who use methamphetamine and examined how benefits and drawbacks of methamphetamine use affect perceived acceptability and preferences. METHODS We conducted qualitative interviews as part of a larger study in 2019-2020. The interview assessed patterns of substance use (including methamphetamine), benefits and drawbacks of methamphetamine use, and interest in a medication to treat MUD. Analysis used an inductive thematic approach, guided by three primary questions: (1) would participants be interested in taking a potential medication for MUD?; (2) what effects would they would like from such a medication?; and (3) what would their ideal treatment route and schedule be (e.g. daily pill, monthly injection)?. RESULTS We interviewed 20 people reporting methamphetamine use in the past 3 months (10 from Reno, Nevada, USA and 10 from Rio Arriba County, New Mexico, USA). Seven used exclusively methamphetamine, while thirteen used other substances in addition to methamphetamine. Most were enthusiastic about a potential medication to treat MUD. Of those who were not interested (n = 5), all indicated no current concerns about their methamphetamine use. Perceived functional benefits of methamphetamine use (i.e., energy, counteracting opioid sedation, and improved social and emotional wellbeing) informed preferences for a replacement-type medication that would confer the same benefits while mitigating drawbacks (e.g., psychosis, hallucinations, withdrawal). Opinions on preferred dosing varied, with some preferring longer acting medications for convenience, while others preferred daily dosing that would align with existing routines. CONCLUSION Participants were excited about a potential for a medication to treat MUD. Their preferences were informed by the functional role of methamphetamine in their lives and a desire to maintain the stimulant effects while mitigating harms of illicit methamphetamine. Treatment outcomes that emphasize functioning and wellbeing, rather than abstinence, should be explored.
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Affiliation(s)
- Karla D Wagner
- School of Public Health, University of Nevada, 1664 N. Virginia St. MC 0274, Reno, NV, 89557, USA.
| | - Charles Marks
- School of Public Health, University of Nevada, 1664 N. Virginia St. MC 0274, Reno, NV, 89557, USA
| | - Phillip Fiuty
- The Mountain Center Harm Reduction Center, 1000 North Paseo de Onate, Española, NM, USA
| | - Robert W Harding
- School of Public Health, University of Nevada, 1664 N. Virginia St. MC 0274, Reno, NV, 89557, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC10 5550, Albuquerque, NM, 87131-0001, USA
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Kolluru GK, Glawe JD, Pardue S, Kasabali A, Alam S, Rajendran S, Cannon AL, Abdullah CS, Traylor JG, Shackelford RE, Woolard MD, Orr AW, Goeders NE, Dominic P, Bhuiyan MSS, Kevil CG. Methamphetamine causes cardiovascular dysfunction via cystathionine gamma lyase and hydrogen sulfide depletion. Redox Biol 2022; 57:102480. [PMID: 36167027 PMCID: PMC9513700 DOI: 10.1016/j.redox.2022.102480] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 12/01/2022] Open
Abstract
Methamphetamine (METH) is an addictive illicit drug used worldwide that causes significant damage to blood vessels resulting in cardiovascular dysfunction. Recent studies highlight increased prevalence of cardiovascular disease (CVD) and associated complications including hypertension, vasospasm, left ventricular hypertrophy, and coronary artery disease in younger populations due to METH use. Here we report that METH administration in a mouse model of 'binge and crash' decreases cardiovascular function via cystathionine gamma lyase (CSE), hydrogen sulfide (H2S), nitric oxide (NO) (CSE/H2S/NO) dependent pathway. METH significantly reduced H2S and NO bioavailability in plasma and skeletal muscle tissues co-incident with a significant reduction in flow-mediated vasodilation (FMD) and blood flow velocity revealing endothelial dysfunction. METH administration also reduced cardiac ejection fraction (EF) and fractional shortening (FS) associated with increased tissue and perivascular fibrosis. Importantly, METH treatment selectively decreased CSE expression and sulfide bioavailability along with reduced eNOS phosphorylation and NO levels. Exogenous sulfide therapy or endothelial CSE transgenic overexpression corrected cardiovascular and associated pathological responses due to METH implicating a central molecular regulatory pathway for tissue pathology. These findings reveal that therapeutic intervention targeting CSE/H2S bioavailability may be useful in attenuating METH mediated cardiovascular disease.
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Affiliation(s)
- Gopi K Kolluru
- Department of Pathology, LSU Health Sciences Center- Shreveport, USA
| | - John D Glawe
- Department of Pathology, LSU Health Sciences Center- Shreveport, USA
| | - Sibile Pardue
- Department of Pathology, LSU Health Sciences Center- Shreveport, USA
| | - Ahmad Kasabali
- Department of Pathology, LSU Health Sciences Center- Shreveport, USA
| | - Shafiul Alam
- Department of Pathology, LSU Health Sciences Center- Shreveport, USA
| | | | - Allison L Cannon
- Department of Pathology, LSU Health Sciences Center- Shreveport, USA
| | | | - James G Traylor
- Department of Pathology, LSU Health Sciences Center- Shreveport, USA
| | | | - Matthew D Woolard
- Department of Microbiology and Immunology, LSU Health Sciences Center- Shreveport, USA
| | - A Wayne Orr
- Department of Pathology, LSU Health Sciences Center- Shreveport, USA; Department of Cellular Biology and Anatomy, LSU Health Sciences Center- Shreveport, USA; Department of Molecular and Cellular Physiology, LSU Health Sciences Center- Shreveport, USA
| | - Nicholas E Goeders
- Department of Pharmacology, Toxicology & Neuroscience, LSU Health Sciences Center- Shreveport, USA
| | - Paari Dominic
- Division of Cardiology Department of Medicine, LSU Health Sciences Center- Shreveport, USA
| | | | - Christopher G Kevil
- Department of Pathology, LSU Health Sciences Center- Shreveport, USA; Department of Cellular Biology and Anatomy, LSU Health Sciences Center- Shreveport, USA; Department of Molecular and Cellular Physiology, LSU Health Sciences Center- Shreveport, USA.
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Curran L, Nah G, Marcus GM, Tseng Z, Crawford MH, Parikh NI. Clinical Correlates and Outcomes of Methamphetamine-Associated Cardiovascular Diseases in Hospitalized Patients in California. J Am Heart Assoc 2022; 11:e023663. [PMID: 35912709 PMCID: PMC9496303 DOI: 10.1161/jaha.121.023663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Methamphetamine misuse affects 27 million people worldwide and is associated with cardiovascular disease (CVD); however, risk factors for CVD among users have not been well studied. Methods and Results We studied hospitalized patients in California, captured by the Healthcare Cost and Utilization Project database, between 2005 and 2011. We studied the association between methamphetamine use and CVD (pulmonary hypertension, heart failure, stroke, and myocardial infarction). Among 20 249 026 persons in the Healthcare Cost and Utilization Project, 66 199 used methamphetamines (median follow‐up 4.58 years). Those who used were more likely younger (33 years versus 45 years), male (63.3% versus 44.4%), smoked, misused alcohol, and had depression and anxiety compared with nonusers. Methamphetamine use was associated with the development of heart failure (hazard ratio [HR], 1.53 [95% CI, 1.45–1.62]) and pulmonary hypertension (HR, 1.42 [95% CI, 1.26–1.60]). Among users, male sex (HR, 1.73 [95% CI, 1.37–2.18]) was associated with myocardial infarction. Chronic kidney disease (HR, 2.38 [95% CI, 1.74–3.25]) and hypertension (HR, 2.26 [95% CI, 2.03–2.51]) were strong risk factors for CVD among users. When compared with nonuse, methamphetamine use was associated with a 32% significant increase in CVD, alcohol abuse with a 28% increase, and cocaine use with a 47% increase in CVD. Conclusions Methamphetamine use has a similar magnitude of risk of CVD compared with alcohol and cocaine. Prevention and treatment could be focused on those with chronic kidney disease, hypertension, and mental health disorders.
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Affiliation(s)
- Lara Curran
- Department of Medicine Division of Cardiology, University of California San Francisco San Francisco CA
| | - Gregory Nah
- Department of Medicine Division of Cardiology, University of California San Francisco San Francisco CA
| | - Gregory M Marcus
- Department of Medicine Division of Cardiology, University of California San Francisco San Francisco CA
| | - Zian Tseng
- Department of Medicine Division of Cardiology, University of California San Francisco San Francisco CA
| | - Michael H Crawford
- Department of Medicine Division of Cardiology, University of California San Francisco San Francisco CA
| | - Nisha I Parikh
- Department of Medicine Division of Cardiology, University of California San Francisco San Francisco CA
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Tobolski J, Sawyer DB, Song SJ, Afari ME. Cardiovascular disease associated with methamphetamine use: a review. Heart Fail Rev 2022; 27:2059-2065. [PMID: 35844009 DOI: 10.1007/s10741-022-10261-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
Methamphetamine abuse is a global epidemic associated with a wide-ranging array of adverse effects on the cardiovascular system including dilated cardiomyopathy, malignant and benign arrhythmias, coronary vasospasm, and atherosclerotic coronary artery disease. While the acute behavioral manifestations of amphetamine abuse are the most easily clinically identified, cardiovascular toxicity is common in this patient population and should be considered in this setting due to its high morbidity and mortality. The specific mechanisms for amphetamine cardiotoxicity have not been fully established, but new research implicates activation of several cellular targets including Sigma-1 receptors and trace amine-associated receptor 1 (TAAR1) leading to a myriad of negative downstream effects including increased reactive oxygenating species (ROS), mitochondrial dysfunction, and modulations of intracellular calcium. Additional pathologic effects are mediated by increased circulating catecholamines, which when chronically activated have well-established adverse effects on the cardiovascular system. In this article, we present a case report followed by a current review of the epidemiology, pathophysiology, diagnosis, and treatment modalities of amphetamine-induced cardiovascular disease.
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Affiliation(s)
- Jared Tobolski
- Cardiac Service Line, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA
| | - Douglas B Sawyer
- Cardiac Service Line, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA
| | - Sharon J Song
- Spectrum Healthcare Partners, South Portland, ME, 04106, USA
| | - Maxwell Eyram Afari
- Cardiac Service Line, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
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Mizuno S, Ono S, Takano A, Yasunaga H, Iwase H. Dental characteristics associated with methamphetamine use: analysis using forensic autopsy data. BMC Oral Health 2022; 22:141. [PMID: 35473930 PMCID: PMC9044830 DOI: 10.1186/s12903-022-02182-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Little is known regarding the oral conditions in nonelderly methamphetamine users, such as the presence of dental caries and periodontitis. We aimed the oral conditions between methamphetamine users and non-users stratified by age groups. Methods In this cross-sectional study, computed tomography images were obtained from 3,338 decedents at two forensic medicine departments in Japan. Decedents aged > 20 or ≤ 64 years were included in the study and categorised into methamphetamine-detected (MA) and undetected (control) groups based on toxicological examinations. Decedents in the MA and control groups were matched for age and sex in a 1:4 ratio. The matched pairs were further categorised into young adults (20–44 years) and middle-aged adults (45–64 years). Oral characteristics, including the decayed, missing, and filled teeth (DMFT) index; periodontitis; distributional patterns of each tooth condition; and occlusal status, were compared between the MA and control groups for each age category. Among 3,338 decedents, 37 young and 55 middle-aged adults in the MA group were matched with 148 and 220 adults in the control group, respectively. Results In the young adult group, methamphetamine use was significantly associated with higher DMFT index (mean [standard deviation], 14.2 [7.6] vs 11.0 [6.1]; p = 0.007), smaller number of filled teeth (2.8 [2.9] vs 5.3 [4.0]; p = 0.001), higher proportion of periodontitis (39.0% vs 6.8%; p < 0.001), and lower proportion of occlusal support (54.1% vs 81.1%; p = 0.001). Young adult methamphetamine users tended to have untreated decayed canines and molars and missing molars. These findings were similar to those in middle-aged adults except the tendency to have missing maxillary incisors. Conclusions Nonelderly methamphetamine users had distinctive oral characteristics that may help screen for methamphetamine abuse through dental examinations. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02182-6.
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Affiliation(s)
- Satomi Mizuno
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ayumi Takano
- Department of Mental Health and Psychiatric Nursing, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, 260-8670, Japan
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11
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Bech AB, Clausen T, Waal H, Delaveris GJM, Skeie I. Organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder: a nation-wide 2-year cross-sectional study. Addiction 2022; 117:977-985. [PMID: 34648218 DOI: 10.1111/add.15705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
AIMS To document organ pathologies detected post-mortem in patients receiving opioid agonist treatment for opioid use disorder and estimate the extent to which individual characteristics are associated with pulmonary, cardiovascular, hepatic or renal pathologies. DESIGN Two-year cross-sectional nation-wide study. SETTING Norway. PARTICIPANTS Among all 200 patients who died during opioid agonist treatment between 1 January 2014 and 31 December 2015, 125 patients (63%) were autopsied. Among these, 122 patients (75% men) had available autopsy reports and were included. The mean age at the time of death was 48 years. MEASUREMENTS Information on pulmonary, cardiovascular, hepatic and renal pathologies were retrieved from forensic or medical autopsy reports, with no (0) and yes (1) as outcome variables and age, sex and body mass index as covariates in logistic regression analyses. FINDINGS Pathologies in several organs were common. Two-thirds (65%) of the decedents had more than two organ system diseases. The most common organ pathologies were chronic liver disease (84%), cardiovascular disease (68%) and pulmonary emphysema (41%). In bivariate analyses, only older age was associated with any pulmonary pathology [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.01-1.10], cardiovascular pathology (OR = 1.11; 95% CI = 1.05-1.17) and renal pathology (OR = 1.05; 95% CI = 1.00-1.11). Older age remained independently associated with cardiovascular pathology (OR = 1.10; 95% CI = 1.04-1.16) and renal pathology (OR = 1.06; 95% CI = 1.01-1.12) adjusted for body mass index and sex. CONCLUSIONS Among autopsied Norwegians who died during opioid agonist treatment in 2014 and 2015, two-thirds had more than two organ system diseases, despite their mean age of 48 years at the time of death. Older age was independently associated with at least one cardiovascular or renal pathology after adjusting for sex and body mass index.
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Affiliation(s)
- Anne Berit Bech
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, Brumunddal, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Helge Waal
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
- National Advisory Unit on Substance Use Disorder Treatment, Oslo University Hospital, Oslo, Norway
| | | | - Ivar Skeie
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Department of Mental Health, Brumunddal, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, Oslo University, Oslo, Norway
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12
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Harding RW, Wagner KT, Fiuty P, Smith KP, Page K, Wagner KD. "It's called overamping": experiences of overdose among people who use methamphetamine. Harm Reduct J 2022; 19:4. [PMID: 35034643 PMCID: PMC8762891 DOI: 10.1186/s12954-022-00588-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The USA is experiencing increases in methamphetamine use and methamphetamine-related or attributed deaths. In the current study, we explore qualitative narratives of methamphetamine overdose and strategies used by people who use drugs to reduce the undesirable effects associated with methamphetamine use. METHODS We conducted 21 qualitative interviews with people over the age of 18 who reported using methamphetamine in the previous 3 months in Nevada and New Mexico. Interviews were recorded, transcribed, and analyzed using qualitative thematic analysis. RESULTS Respondents described a constellation of psychological and physical symptoms that they characterized as "overamping," experienced on a continuum from less to more severe. Reports of acute, fatal methamphetamine overdose were rare. Few reported seeking medical attention for undesirable effects (usually related to psychological effects). General self-care strategies such as sleeping and staying hydrated were discussed. CONCLUSIONS When asked directly, our respondents claimed that acute, fatal methamphetamine overdose is rare or even impossible. However, they described a number of undesirable symptoms associated with overconsumption of methamphetamine and had few clinical or harm reduction strategies at their disposal. Addressing this current wave of drug-related deaths will require attention to the multiple factors that structure experiences of methamphetamine "overdose," and a collaborative effort with PWUDs to devise effective harm reduction and treatment strategies.
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Affiliation(s)
- Robert W. Harding
- grid.266818.30000 0004 1936 914XSchool of Public Health, University of Nevada, Reno, 1664 N. Virginia St. MC 0274, Reno, NV 89509 USA
| | - Katherine T. Wagner
- grid.266832.b0000 0001 2188 8502University of New Mexico Health Sciences Center, Albuquerque, NM USA
| | - Phillip Fiuty
- The Mountain Center Harm Reduction Center, Santa Fe, NM USA
| | - Krysti P. Smith
- grid.266818.30000 0004 1936 914XSchool of Public Health, University of Nevada, Reno, 1664 N. Virginia St. MC 0274, Reno, NV 89509 USA
| | - Kimberly Page
- grid.266832.b0000 0001 2188 8502University of New Mexico Health Sciences Center, Albuquerque, NM USA
| | - Karla D. Wagner
- grid.266818.30000 0004 1936 914XSchool of Public Health, University of Nevada, Reno, 1664 N. Virginia St. MC 0274, Reno, NV 89509 USA
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Lewis D, van den Heuvel C, Kenneally M, Byard RW. Methamphetamine use and the risk of diabetic ketoacidosis. MEDICINE, SCIENCE, AND THE LAW 2022; 62:39-42. [PMID: 34102917 DOI: 10.1177/00258024211020936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Diabetic ketoacidosis (DKA) is a life-threatening condition arising in individuals with insulin-dependent diabetes mellitus, associated with hyperglycaemia and hyperketonaemia. While drugs such as methadone, cocaine and certain prescription medications may precipitate DKA, the potential effect of methamphetamine is unclear. Analysis of autopsy and toxicology case files at Forensic Science SA, Adelaide, South Australia, was therefore undertaken from 1 January to 31 December 2019 of all cases where methamphetamine was detected in post-mortem blood samples. There were 94 cases with 11 diabetics (n = 6 type 1 and n = 5 type 2). Four of the six decedents with type 1 diabetes had lethal DKA (66.7%; age range 30-54 years; average age 44.6 ± 10.5 years; M:F ratio 1:1). This incidence of DKA was higher than that of the general insulin-dependent diabetic population (6%) and also significantly higher than in medico-legal cases (13%; p < 0.05). The clinical and autopsy assessment of insulin-dependent diabetics presenting with DKA should therefore include specific screening for methamphetamine. The increase in both insulin-dependent diabetes and methamphetamine abuse in the community may lead to increases in such cases in medico-legal and health contexts.
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Affiliation(s)
- Daniel Lewis
- Adelaide Medical School, The University of Adelaide, Australia
| | | | | | - Roger W Byard
- Adelaide Medical School, The University of Adelaide, Australia
- Forensic Science SA, Australia
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Extracellular Vesicle-Encapsulated miR-183-5p from Rhynchophylline-Treated H9c2 Cells Protect against Methamphetamine-Induced Dependence in Mouse Brain by Targeting NRG1. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2136076. [PMID: 34484386 PMCID: PMC8416368 DOI: 10.1155/2021/2136076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 12/31/2022]
Abstract
Methamphetamine (Meth) is a highly addictive substance and the largest drug threat across the globe. There is evidence to indicate that Meth use has serious damage on central nervous system (CNS) and heart in several animal and human studies. However, the connection in the process of Meth addiction between these two systems has not been determined. Emerging data suggest that extracellular vesicles (EVs) carrying behavior-altering microRNA (miRNAs) play a crucial role in cell communication between CNS and peripheral system. Rhynchophylline (Rhy), an antiaddictive alkaloid, was used to protect the brain and heart from Meth-induced damage, which has caught our attention. Here, we used Meth-dependent conditioned place preference (CPP) animal model and cell model to verify the protective effect of Rhy-treated EVs. Further, small RNA sequencing analysis, qPCR, dual-luciferase reporter assay, and transfection test were used to identify the key EVs-encapsulated miRNAs, isolated from cultured H9c2 cells with different treatments, involved in the therapeutic effect and the underlying mechanisms of Rhy. The results demonstrate that Rhy-treated EVs exert protective effects against Meth dependence through the pathway of miR-183-5p-neuregulin-1 (NRG1). Our collective findings provide novel insights into the roles of EVs miRNAs in Meth addiction and support their potential application in the development of novel therapeutic approaches.
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15
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Mizuno S, Ono S, Yasunaga H, Iwase H. Factors associated with methamphetamine use in Japanese people who died of unnatural causes: Analysis using forensic autopsy reports. Forensic Sci Int 2021; 327:110946. [PMID: 34464922 DOI: 10.1016/j.forsciint.2021.110946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/02/2021] [Accepted: 08/15/2021] [Indexed: 11/27/2022]
Abstract
This study aimed to examine factors related to methamphetamine use in Japanese people who died of unnatural causes. This study used a cross-sectional design. A total of 3343 forensic autopsy reports were obtained from two forensic medicine departments in the Kanto region of Japan. We classified the decedents who underwent forensic autopsies into methamphetamine/amphetamine (MA) and undetected (comparison) groups based on toxicological examination. We matched the decedents in the MA group with those in the comparison group at a 1:4 ratio based on sex and age. The variables, including gang members, criminal records, tattoos, body mass index, infections, concurrent psychotropic drug use, and cause of death, were compared between the groups. Of the 3343 decedents, we matched 109 in the MA group with 436 in the comparison group. Methamphetamine use was significantly associated with gang membership (13.8% vs. 3%, p < 0.001), criminal records unrelated to methamphetamine (47.7% vs. 13.8%, p < 0.001), tattoos (29.2% vs. 6.4%, p < 0.001), and hepatitis C virus infection (48.0% vs. 3.6%, p < 0.001). One-third of the patients in the MA group died from poisoning. This is the first study to show the physical and social characteristics associated with methamphetamine use in Japanese people who died of unnatural causes. Our results could be extended to people with methamphetamine use disorder at risk of death and enable the development of policies and practices to provide necessary intervention in a timely manner.
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Affiliation(s)
- Satomi Mizuno
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan.
| | - Sachiko Ono
- Department of Eat-loss Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan.
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba Prefecture 260-8670, Japan.
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16
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Clinical Differences and Outcomes between Methamphetamine-associated and Idiopathic Pulmonary Arterial Hypertension in the Pulmonary Hypertension Association Registry. Ann Am Thorac Soc 2021; 18:613-622. [PMID: 33064950 DOI: 10.1513/annalsats.202007-774oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Single-center studies demonstrated that methamphetamine use is associated with pulmonary arterial hypertension (Meth-APAH). We used the Pulmonary Hypertension Association Registry to evaluate the national distribution of Meth-APAH and to compare its impact on patient-reported and clinical outcomes relative to idiopathic PAH.Objectives: To determine if patients with Meth-APAH differ from those with idiopathic PAH in demographics, regional distribution in the United States, hemodynamics, health-related quality of life, PAH-specific treatment, and health care use.Methods: The Pulmonary Hypertension Association Registry is a U.S.-based prospective cohort of patients new to care at a Pulmonary Hypertension Care Center. The registry collects baseline demographics, clinical parameters, and repeated measures of health-related quality of life, World Health Organization functional class, 6-minute walk distance, therapy, and health care use. Repeated measures of functional class, health-related quality of life, type of therapy, emergency department visits, and hospitalizations were compared using generalized estimating equations.Results: Of 541 participants included, 118 had Meth-APAH; 83% of Meth-APAH arose in the western United States. The Meth-APAH group was younger and had a poorer socioeconomic status and lower cardiac index than the idiopathic PAH group, despite no difference in mean pulmonary artery pressure or pulmonary vascular resistance. The Meth-APAH group had a more advanced functional class in longitudinal models (0.22 points greater; 95% confidence interval [CI], 0.07 to 0.37) and worse PAH-specific (emPHasis-10) health-related quality of life (-5.4; 95% CI, -8.1 to -2.8). There was no difference in dual combination therapy; however, participants with Meth-APAH were less likely to be initiated on triple therapy (odds ratio [OR], 0.43; 95% CI, 0.24 to 0.77) or parenteral therapy (OR, 0.10; 95% CI, 0.04 to 0.24). Participants with Meth-APAH were more likely to seek care in the emergency department (incidence rate ratio, 2.30; 95% CI, 1.71 to 3.11) and more likely to be hospitalized (incidence rate ratio, 1.42; 95% CI, 1.10 to 1.83).Conclusions: Meth-APAH represents a unique clinical phenotype of PAH, most common in the western United States. It accounts for a notable proportion of PAH in expert centers. Assessment for methamphetamine use is necessary in patients with PAH.
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Lewis D, Kenneally M, van denHeuvel C, Byard RW. Methamphetamine deaths: Changing trends and diagnostic issues. MEDICINE, SCIENCE, AND THE LAW 2021; 61:130-137. [PMID: 33423599 DOI: 10.1177/0025802420986707] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The term 'amphetamine' refers to a class of synthetic drugs which includes methamphetamine. The latter is a globally popular drug of abuse which induces euphoria, affecting cognitive/psychomotor performance and sleep. It also provokes risk taking and violent behaviour. The central effects of methamphetamine are due to the overproduction of neurotransmitters, resulting in high levels of dopamine. In recent years, there have been significant increases in cases of methamphetamine abuse in North and South America, Australia and Asia due to its ready availability and low cost. The following review examines changing trends in methamphetamine use and problems that arise diagnostically in medico-legal cases in determining the significance of post-mortem blood levels, the relationship of these to ante-mortem levels, the possible effects on physical and psychological behaviours and the possible contribution of the drug to a lethal episode.
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Affiliation(s)
- Daniel Lewis
- Adelaide Medical School, The University of Adelaide, Australia
| | | | | | - Roger W Byard
- Adelaide Medical School, The University of Adelaide, Australia
- Forensic Science SA, Australia
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18
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Methamphetamine-related postmortem cases in Jeddah, Saudi Arabia. Forensic Sci Int 2021; 321:110746. [PMID: 33676238 DOI: 10.1016/j.forsciint.2021.110746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 01/13/2023]
Abstract
A more than 500% increase in the number of deaths involving methamphetamine occurred between 2016 and 2018 in Jeddah, Saudi Arabia. As such, this report employed a validated liquid chromatography tandem mass spectrometry method to quantify methamphetamine and its metabolites in bodily fluids from 47 postmortem cases in which methamphetamine was involved. The mean age of the deceased was 33 years old (median: 30, range: 16-63), and 94% were male. Methamphetamine was co-ingested with another drug in 32 of the cases (68%); however, the deaths were only due to the combined toxicity of methamphetamine and another drug in 15 of the cases (32%). Of note, 13 of these deaths (28% of all deaths) involved heroin. When methamphetamine was the sole cause of death (32% of the studied cases), the median concentrations of methamphetamine and amphetamine were 527 and 128 ng/mL. When methamphetamine was combined toxicity with another drug, the median concentrations of methamphetamine and amphetamine decreased to 161 and 53 ng/mL. When deaths were unrelated to methamphetamine, the median concentrations of methamphetamine and amphetamine were 130 and 44 ng/mL, respectively. The highest median methamphetamine concentration was found in urine (5281 ng/mL), followed by stomach contents (878 ng/mL), bile (762 ng/mL), vitreous humor (3 ng/mL), and blood (208 ng/mL). Almost 40% of the studied cases involved violence, 61% were accidental, 21% were suicides, 17% were homicides, and 2% were natural deaths. Methamphetamine is highly addictive. Increases in deaths have been seen in various countries. More awareness, education and treatment programs are required to reduce the likelihood of addiction, crimes, suicide, and other fatalities resulting from methamphetamine abuse.
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Scott ML, Murnane KS, Orr AW. Young at heart? Drugs of abuse cause early-onset cardiovascular disease in the young. Heart 2021; 107:604-606. [PMID: 33589426 DOI: 10.1136/heartjnl-2020-318856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Matthew L Scott
- Department of Pathology, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Kevin S Murnane
- Departments of Pharmacology, Toxicology and Neuroscience and Psychiatry, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Anthony Wayne Orr
- Departments of Pathology, Cellular Biology and Anatomy, and Molecular and Cellular Physiology, LSU Health Shreveport, Shreveport, Louisiana, USA
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Blum K, Cadet JL, Gold MS. Psychostimulant use disorder emphasizing methamphetamine and the opioid -dopamine connection: Digging out of a hypodopaminergic ditch. J Neurol Sci 2021; 420:117252. [PMID: 33279726 DOI: 10.1016/j.jns.2020.117252] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Approved food and drug administration (FDA) medications to treat Psychostimulant Use Disorder (PUD) are needed. Both acute and chronic neurological deficits related to the neurophysiological effects of these powerfully addictive drugs can cause stroke and alterations in mood and cognition. OBJECTIVE This article presents a brief review of the psychiatric and neurobiological sequelae of methamphetamine use disorder, some known neurogenetic associations impacted by psychostimulants, and explores treatment modalities and outcomes. HYPOTHESIS The authors propose that gentle D2 receptor stimulation accomplished via some treatment modalities can induce dopamine release, causing alteration of D2-directed mRNA and thus enhanced function of D2 receptors in the human. This proliferation of D2 receptors, in turn, will induce the attenuation of craving behavior, especially in genetically compromised high-risk populations. DISCUSSION A better understanding of the involvement of molecular neurogenetic opioid, mesolimbic dopamine, and psychostimulant connections in "wanting" supports this hypothesis. While both scientific and, clinical professionals search for an FDA approved treatment for PUD the induction of dopamine homeostasis, via activation of the brain reward circuitry, offers treatment for underlying neurotransmitter functional deficits, potential prophylaxis, and support for recovery efforts. CONCLUSION Dopamine regulation may help people dig out of their hypodopaminergia ditch.
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Affiliation(s)
- Kenneth Blum
- Graduate College, Western University Health Sciences, Pomona, CA, Baltimore, MD, United States of America.
| | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, NIH National Institute on Drug Abuse, United States of America
| | - Mark S Gold
- Department of Psychiatry, Washington University, St Louis, MO, United States of America.
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21
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Rodriguez EA, Yamamoto BK. Toxic Effects of Methamphetamine on Perivascular Health: Co-morbid Effects of Stress and Alcohol Use Disorders. Curr Neuropharmacol 2021; 19:2092-2107. [PMID: 34344290 PMCID: PMC9185763 DOI: 10.2174/1570159x19666210803150023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 12/04/2022] Open
Abstract
Methamphetamine (Meth) abuse presents a global problem and commonly occurs with stress and/or alcohol use disorders. Regardless, the biological causes and consequences of these comorbidities are unclear. Whereas the mechanisms of Meth, stress, and alcohol abuse have been examined individually and well-characterized, these processes overlap significantly and can impact the neural and peripheral consequences of Meth. This review focuses on the deleterious cardio- and cerebrovascular effects of Meth, stress, alcohol abuse, and their comorbid effects on the brain and periphery. Points of emphasis are on the composition of the blood-brain barrier and their effects on the heart and vasculature. The autonomic nervous system, inflammation, and oxidative stress are specifically highlighted as common mediators of the toxic consequences to vascular and perivascular health. A significant portion of the Meth abusing population also presents with stress and alcohol use disorders, prompting a need to understand the mechanisms underlying their comorbidities. Little is known about their possible convergent effects. Therefore, the purpose of this critical review is to identify shared mechanisms of Meth, chronic stress, and alcohol abuse that contributes to the dysfunction of vascular health and underscores the need for studies that directly address their interactions.
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Affiliation(s)
- Eric A. Rodriguez
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bryan K. Yamamoto
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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22
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Heart Failure in Vulnerable Populations: The Emerging Evidence of Methamphetamine-Associated Cardiomyopathy. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00653-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Freeling JL, McFadden LM. The emergence of cardiac changes following the self-administration of methamphetamine. Drug Alcohol Depend 2020; 212:108029. [PMID: 32408136 PMCID: PMC7293916 DOI: 10.1016/j.drugalcdep.2020.108029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/16/2020] [Accepted: 04/13/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Clinical observations suggest an association between methamphetamine (METH) use and cardiovascular disease, but preclinical studies are lacking. The purpose of the current study was to explore changes in left ventricular function as a potential precursor to cardiovascular disease in a rodent model of METH use. METHODS Male rats were allowed to self-administer either METH or saline for 9 d. On the day following the 4th and 9th self-administration sessions, an echocardiogram was performed to assess left-ventricular parameters under basal conditions and following a low-dose of METH (1 mg/kg). RESULTS A low challenge dose of METH resulted in subtle but statistically significant changes in cardiac function during the echocardiogram in both the METH and saline self-administering groups. Further, differences in left-ventricular parameters such as stroke volume and heart rate were observed between METH and saline groups following the 9th self-administration session. Finally, supervised machine learning correctly predicted the self-administration group assignment (saline or METH) using cardiac parameters following the 9th self-administration session. CONCLUSIONS The findings of the current study suggest the heart, specifically the left ventricle, is sensitive to METH. Overall, these findings and emerging clinical observations highlight the need for research to investigate the effects of METH use on the heart.
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Affiliation(s)
- Jessica L. Freeling
- Physiology Core, Division of Basic Biomedical Sciences, University of South Dakota, Vermillion SD 57069
| | - Lisa M. McFadden
- Center for Brain and Behavioral Research, Division of Basic Biomedical Sciences, University of South Dakota, Vermillion SD 57069
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Reddy PKV, Ng TMH, Oh EE, Moady G, Elkayam U. Clinical Characteristics and Management of Methamphetamine-Associated Cardiomyopathy: State-of-the-Art Review. J Am Heart Assoc 2020; 9:e016704. [PMID: 32468897 PMCID: PMC7428977 DOI: 10.1161/jaha.120.016704] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Methamphetamine‐associated cardiomyopathy (MACM) is an increasingly recognized disease entity in the context of a rapidly spreading methamphetamine epidemic. MACM may afflict individuals with a wide range of ages and socioeconomic backgrounds. Presentations can vary greatly and may involve several complications unique to the disease. Given the public health significance of this disease, there is a relative dearth of consensus material to guide clinicians in understanding, diagnosing, and managing MACM. This review therefore aims to: (1) describe pathologic mechanisms of methamphetamine as they pertain to the development, progression, and prognosis of MACM, and the potential to recover cardiac function; (2) summarize existing data from epidemiologic studies and case series in an effort to improve recognition and diagnosis of the disease; (3) guide short‐ and long‐term management of MACM with special attention to expected or potential sequelae of the disease; and (4) highlight pivotal unanswered questions in need of urgent investigation from a public health perspective.
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Affiliation(s)
- Pavan K V Reddy
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
| | - Tien M H Ng
- School of Pharmacy University of Southern California Los Angeles CA
| | - Esther E Oh
- School of Pharmacy University of Southern California Los Angeles CA
| | - Gassan Moady
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
| | - Uri Elkayam
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
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25
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Soo JY, Wiese MD, Dyson RM, Gray CL, Clarkson AN, Morrison JL, Berry MJ. Methamphetamine administration increases hepatic CYP1A2 but not CYP3A activity in female guinea pigs. PLoS One 2020; 15:e0233010. [PMID: 32396581 PMCID: PMC7217439 DOI: 10.1371/journal.pone.0233010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 04/28/2020] [Indexed: 11/18/2022] Open
Abstract
Methamphetamine use has increased over the past decade and the first use of methamphetamine is most often when women are of reproductive age. Methamphetamine accumulates in the liver; however, little is known about the effect of methamphetamine use on hepatic drug metabolism. Methamphetamine was administered on 3 occassions to female Dunkin Hartley guinea pigs of reproductive age, mimicking recreational drug use. Low doses of test drugs caffeine and midazolam were administered after the third dose of methamphetamine to assess the functional activity of cytochrome P450 1A2 and 3A, respectively. Real-time quantitative polymerase chain reaction was used to quantify the mRNA expression of factors involved in glucocorticoid signalling, inflammation, oxidative stress and drug transporters. This study showed that methamphetamine administration decreased hepatic CYP1A2 mRNA expression, but increased CYP1A2 enzyme activity. Methamphetamine had no effect on CYP3A enzyme activity. In addition, we found that methamphetamine may also result in changes in glucocorticoid bioavailability, as we found a decrease in 11β-hydroxysteroid dehydrogenase 1 mRNA expression, which converts inactive cortisone into active cortisol. This study has shown that methamphetamine administration has the potential to alter drug metabolism via the CYP1A2 metabolic pathway in female guinea pigs. This may have clinical implications for drug dosing in female methamphetamine users of reproductive age.
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Affiliation(s)
- Jia Yin Soo
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, Australia
- Health and Biomedical Innovation, University of South Australia, Adelaide, Australia
| | - Michael D. Wiese
- Health and Biomedical Innovation, University of South Australia, Adelaide, Australia
| | - Rebecca M. Dyson
- Department of Paediatrics and Child Health, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Clint L. Gray
- Department of Paediatrics and Child Health, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Andrew N. Clarkson
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Janna L. Morrison
- Early Origins of Adult Health Research Group, University of South Australia, Adelaide, Australia
- Health and Biomedical Innovation, University of South Australia, Adelaide, Australia
- * E-mail: (JLM); (MJB)
| | - Mary J. Berry
- Department of Paediatrics and Child Health, Brain Health Research Centre and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
- * E-mail: (JLM); (MJB)
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26
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Duflou J. Psychostimulant use disorder and the heart. Addiction 2020; 115:175-183. [PMID: 31321853 DOI: 10.1111/add.14713] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/08/2019] [Accepted: 06/10/2019] [Indexed: 01/07/2023]
Abstract
Psychostimulants are a diverse range of substances that encompass cocaine and the phenylethylamines, the latter including the amphetamines, cathinones and some 'novel psychoactive substances'. This paper examines the range of pathophysiological processes, clinical presentations and treatment options involving the heart and cardiovascular system both in the acute setting and where long-term effects of psychostimulant use have affected the cardiovascular system. A common feature of these drugs is their effect on the cardiovascular system, where their major action is that of sympathomimetic amines with short- and long-term stimulation of the adrenergic system and consequent effects on blood pressure, cardiac modelling, atherogenesis and cellular calcium signalling. Cocaine additionally exhibits a variety of prothrombotic effects, effects on inflammatory mediators and alterations in myocardial gene expression. Persistent psychostimulant use results in progressive cardiovascular pathology, largely in the form of accelerated atherosclerosis, hypertension and myocardial ischaemia. Abstinence results in at least partial reversal of pathology. To a large extent, an assumption is made that treatment protocols used for cocaine-associated cardiovascular pathology apply to the amphetamines and other phenylethylamines, but there appears to be little research in this area, despite acknowledgement that cocaine and the better-known amphetamines have different modes of action.
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Affiliation(s)
- Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
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27
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A Mechanistic and Pathophysiological Approach for Stroke Associated with Drugs of Abuse. J Clin Med 2019; 8:jcm8091295. [PMID: 31450861 PMCID: PMC6780697 DOI: 10.3390/jcm8091295] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/16/2022] Open
Abstract
Drugs of abuse are associated with stroke, especially in young individuals. The major classes of drugs linked to stroke are cocaine, amphetamines, heroin, morphine, cannabis, and new synthetic cannabinoids, along with androgenic anabolic steroids (AASs). Both ischemic and hemorrhagic stroke have been reported due to drug abuse. Several common mechanisms have been identified, such as arrhythmias and cardioembolism, hypoxia, vascular toxicity, vascular spasm and effects on the thrombotic mechanism, as causes for ischemic stroke. For hemorrhagic stroke, acute hypertension, aneurysm formation/rupture and angiitis-like changes have been implicated. In AAS abuse, the effect of blood pressure is rather substance specific, whereas increased erythropoiesis usually leads to thromboembolism. Transient vasospasm, caused by synthetic cannabinoids, could lead to ischemic stroke. Opiates often cause infective endocarditis, resulting in ischemic stroke and hypereosinophilia accompanied by pyogenic arthritis, provoking hemorrhagic stroke. Genetic variants are linked to increased risk for stroke in cocaine abuse. The fact that case reports on cannabis-induced stroke usually refer to the young population is very alarming.
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28
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Kevil CG, Goeders NE, Woolard MD, Bhuiyan MS, Dominic P, Kolluru GK, Arnold CL, Traylor JG, Orr AW. Methamphetamine Use and Cardiovascular Disease. Arterioscler Thromb Vasc Biol 2019; 39:1739-1746. [PMID: 31433698 DOI: 10.1161/atvbaha.119.312461] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
While the opioid epidemic has garnered significant attention, the use of methamphetamines is growing worldwide independent of wealth or region. Following overdose and accidents, the leading cause of death in methamphetamine users is cardiovascular disease, because of significant effects of methamphetamine on vasoconstriction, pulmonary hypertension, atherosclerotic plaque formation, cardiac arrhythmias, and cardiomyopathy. In this review, we examine the current literature on methamphetamine-induced changes in cardiovascular health, discuss the potential mechanisms regulating these varied effects, and highlight our deficiencies in understanding how to treat methamphetamine-associated cardiovascular dysfunction.
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Affiliation(s)
- Christopher G Kevil
- From the Departments of Pathology and Translational Pathobiology (C.G.K., M.S.B., G.K.K., J.G.T., A.W.O.), LSU Health Sciences Center, Shreveport, LA.,Cellular and Molecular Physiology (C.G.K., M.S.B., A.W.O.), LSU Health Sciences Center, Shreveport, LA.,Cell Biology and Anatomy (C.G.K., A.W.O.), LSU Health Sciences Center, Shreveport, LA
| | - Nicholas E Goeders
- Pharmacology, Toxicology, and Neuroscience (N.E.G.), LSU Health Sciences Center, Shreveport, LA
| | - Matthew D Woolard
- Microbiology and Immunology (M.D.W.), LSU Health Sciences Center, Shreveport, LA
| | - Md Shenuarin Bhuiyan
- From the Departments of Pathology and Translational Pathobiology (C.G.K., M.S.B., G.K.K., J.G.T., A.W.O.), LSU Health Sciences Center, Shreveport, LA.,Cellular and Molecular Physiology (C.G.K., M.S.B., A.W.O.), LSU Health Sciences Center, Shreveport, LA
| | - Paari Dominic
- Medicine (P.D., C.L.A.), LSU Health Sciences Center, Shreveport, LA
| | - Gopi K Kolluru
- From the Departments of Pathology and Translational Pathobiology (C.G.K., M.S.B., G.K.K., J.G.T., A.W.O.), LSU Health Sciences Center, Shreveport, LA
| | - Connie L Arnold
- Medicine (P.D., C.L.A.), LSU Health Sciences Center, Shreveport, LA
| | - James G Traylor
- From the Departments of Pathology and Translational Pathobiology (C.G.K., M.S.B., G.K.K., J.G.T., A.W.O.), LSU Health Sciences Center, Shreveport, LA
| | - A Wayne Orr
- From the Departments of Pathology and Translational Pathobiology (C.G.K., M.S.B., G.K.K., J.G.T., A.W.O.), LSU Health Sciences Center, Shreveport, LA.,Cellular and Molecular Physiology (C.G.K., M.S.B., A.W.O.), LSU Health Sciences Center, Shreveport, LA.,Cell Biology and Anatomy (C.G.K., A.W.O.), LSU Health Sciences Center, Shreveport, LA
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Prakobsrikul P, Srisont S, Jinawath A, Boonkrem M. Methamphetamine-related post-mortem cases in Bangkok, Thailand. MEDICINE, SCIENCE, AND THE LAW 2019; 59:164-170. [PMID: 31159636 DOI: 10.1177/0025802419852800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction This study investigated variables associated with methamphetamine-related deaths in Thailand. Methods This study used data obtained from methamphetamine-related autopsy cases over a six-year period from 2011 to 2016. From the data available during this period, considered variables included: demographic, toxicological and histopathological profiles. Methamphetamine blood concentration calculations and myoglobin immunostainings in kidney samples were also carried out. Statistical analysis and tests of significance were conducted using a paired-sample t-test, adopting a p-value of 0.05. Results A total of 61 methamphetamine-related cases were reviewed. Of several pathological findings, cardiovascular pathological findings were the most common. Cases were divided into a non-trauma group ( n = 19; 31.15%) and a trauma group ( n = 42; 68.85%), and it was found that methamphetamine blood concentrations of non-trauma cases were largely in therapeutic ranges. The differences between methamphetamine concentrations of trauma and non-trauma groups were not statistically significant ( p > 0.05). Immunostainings for myoglobin in kidney samples were positive in two non-trauma cases, which is suggestive of methamphetamine-induced rhabdomyolysis. Conclusions Methamphetamine intoxication causes cardiac toxicity and can cause death. However, methamphetamine quantitation, autopsy findings and scene investigations are considered altogether in determination of cause of death due to many factors such as drug tolerances. Myoglobin immunostaining was found to be a useful tool in determining cause of death.
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Affiliation(s)
- Piyatida Prakobsrikul
- Forensic Division, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
| | - Smith Srisont
- Forensic Division, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
| | - Artit Jinawath
- Forensic Division, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
| | - Manee Boonkrem
- Forensic Division, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
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30
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Takeichi T, Hori O, Hattori T, Kiryu K, Zuka M, Kitamura O. Pre-administration of low-dose methamphetamine enhances movement and neural activity after high-dose methamphetamine administration in the striatum. Neurosci Lett 2019; 703:119-124. [DOI: 10.1016/j.neulet.2019.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/24/2022]
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31
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Estes MK, Freels TG, Prater WT, Lester DB. Systemic oxytocin administration alters mesolimbic dopamine release in mice. Neuroscience 2019; 408:226-238. [DOI: 10.1016/j.neuroscience.2019.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 12/16/2022]
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32
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Darke S, Kaye S, Duflou J, Lappin J. Completed Suicide Among Methamphetamine Users: A National Study. Suicide Life Threat Behav 2019; 49:328-337. [PMID: 29444345 DOI: 10.1111/sltb.12442] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022]
Abstract
All Australian cases of methamphetamine-related suicide (2009-2015) retrieved from the National Coronial Information System were examined to determine crude mortality rates, characteristics and circumstances of death, and blood toxicology. There were 300 cases, 18.2% of all methamphetamine-related deaths, and 1.6% of all completed suicides. The mean age was 33.1 years, and 77.0% were male. The crude mortality rate was 1.9 per 106 , with males having a significantly higher rate than females (2.9 vs. 0.9 per 106 ). A quarter were known to have previous suicide attempts, and a history of psychosis was noted in 12.3%. In 40.7% of cases, witnesses described the decedent as having been agitated and/or aggressive immediately prior to the incident. The vast majority (85.3%), and of both sexes (males 87.0%, females 79.7%), used violent methods. Hanging (70.3%) was overwhelmingly the most frequent method among both males (70.1%) and females (71.0%). Prescription medications were frequently present: hypnosedatives (23.6%), antidepressants (19.5%), and antipsychotics (8.4%). Self-poisoning cases were significantly more likely to have antidepressants (odds ratio: 4.2) and opioids (4.9) present, but less likely to have cannabis (0.3). Methamphetamine-related suicide makes a large contribution to methamphetamine-related death and represents a substantial clinical and public health problem.
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Affiliation(s)
- Shane Darke
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Sharlene Kaye
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,Justice Health and Forensic Mental Health Network, NSW Health, Sydney, NSW, Australia
| | - Johan Duflou
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Julia Lappin
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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33
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Fluyau D, Mitra P, Lorthe K. Antipsychotics for Amphetamine Psychosis. A Systematic Review. Front Psychiatry 2019; 10:740. [PMID: 31681046 PMCID: PMC6804571 DOI: 10.3389/fpsyt.2019.00740] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/16/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Among individuals experiencing amphetamine psychosis, it may be difficult to rule out schizophrenia. The use of antipsychotics for the treatment of amphetamine psychosis is sparse due to possible side effects. Some arguments disfavor their use, stating that the psychotic episode is self-limited. Without treatment, some individuals may not fully recover from the psychosis and may develop full-blown psychosis, emotional, and cognitive disturbance. This review aims to investigate the clinical benefits and risks of antipsychotics for the treatment of amphetamine psychosis. Methods: Electronic search on trials on antipsychotic drugs for amphetamine psychosis from their inception to November 2018 was conducted in PubMed, Scopus, Google Scholar, EBSCOhost, ProQuest, Cochrane Review Database, Medline Ovid, and EMBASE following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The Cochrane risk-of-bias tool assessed the risk of bias, the methodological quality of individual trials was assessed by the Oxford Quality Scoring System, and the quality of evidence for recommendations was judged by the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). The results were synthesized qualitatively and quantitatively. Results: The investigation of six randomized controlled trials of 314 participants showed that aripiprazole, haloperidol, quetiapine, olanzapine, and risperidone were able to reduce or control the psychotic episode (positive and negative symptoms) induced by amphetamine use with no adverse event. Although the side-effect profile of these agents varied, no drug was clinically superior to others. Conclusions: This review suggests that antipsychotics seem to be efficacious for amphetamine psychosis on both positive and negative symptoms. Practitioners need to tailor their use based on risks for side effects individually.
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Affiliation(s)
- Dimy Fluyau
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Paroma Mitra
- Langone Health, Department of Psychiatry, NYU, New York, NY, United States
| | - Kervens Lorthe
- Department of Health, Miami Regional University, Miami Springs, FL, United States
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34
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Hall W. The future of the international drug control system and national drug prohibitions. Addiction 2018; 113:1210-1223. [PMID: 28884869 DOI: 10.1111/add.13941] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/21/2017] [Accepted: 07/10/2017] [Indexed: 01/17/2023]
Abstract
A major impediment to any nation abandoning the policy of drug prohibition has been the fact that international drug treaties to which the majority of United Nations (UN) member states are signatory prohibit the non-medical use of amphetamines, cannabis, cocaine and heroin. The future of these treaties is now uncertain because of decisions by Uruguay, eight US states and Canada to legalize cannabis use. This paper: (1) provides a brief account of the international drug control treaties; (2) outlines the major criticisms of the treaties; (3) analyses critically proposals for treaty reform; and (4) provides a personal view on policies that nation states could adopt to minimize the harms from the use of cannabis, party drugs and hallucinogens, opioids, stimulants and new psychoactive substances. It is argued that: a major risk of cannabis legalization in the United States is promotion of heavy use and increased harm by a weakly regulated industry; some cautious national experiments with the regulation of party drugs and hallucinogens would be informative; a strong case remains for prohibiting the nonmedical use of opioids while mitigating the adverse effects that this policy has on opioid-dependent people; stimulant legalization will probably increase problem use but prohibition is difficult to enforce, highlighting the urgency of finding better ways to reduce demand for these drugs and respond to problem users; and that it is unclear what the best approach is to reducing possible harms that may arise from the use of new psychoactive substances.
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Affiliation(s)
- Wayne Hall
- National Addiction Centre, Institute of Psychiatry, Psychiatry and Neuroscience, King's College, London, London, UK.,The Centre for Youth Substance Abuse Research, The University of Queensland, Herston, QLD, Australia.,National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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35
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Aregbesola A, Onyeka IN, Olubamwo O, Ronkainen K, Tiihonen J, Föhr J, Kauhanen J. Diabetes hospitalizations and deaths in a cohort of treatment-seeking illicit drug users. SAGE Open Med 2018; 6:2050312118768164. [PMID: 29881602 PMCID: PMC5987891 DOI: 10.1177/2050312118768164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 03/08/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Studies on diabetes among illicit drug users are scarce in Finland. This study aimed to describe hospitalization and death due to diabetes among treatment-seeking illicit drug users. Methods: Information of 4817 treatment-seeking drug users (3365 men and 1452 women) aged 11–65 years (mean 24.5 years) was linked to the Finnish national hospital discharge register and the national death registry to identify those clients who were hospitalized or died from diabetes mellitus during 1997–2013. Results: Fifty-three persons (42 men and 11 women) had primary diagnoses of diabetes, with a total of 146 hospitalizations (121 among men and 25 among women). The total length of stay among men (1183 days) far exceeded those of women (138 days). Overall, type 1 diabetes was the main contributor to hospitalizations (67%, n = 98/146). The proportion of Type 1 diabetes with complications was 31% in men (n = 37/121) and 44% in women (n = 11/25). All cases of deaths due to diabetes (n = 7) occurred in men. Conclusion: Diabetes hospitalizations were mainly due to Type 1 diabetes. Longer length of hospital stay was observed in men, and all diabetes deaths occurred among men. Male drug users and drug users in general would require more support to reduce morbidity and mortality due to diabetes.
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Affiliation(s)
- Alex Aregbesola
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ifeoma N Onyeka
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olubunmi Olubamwo
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kimmo Ronkainen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jaana Föhr
- Helsinki Deaconess Institute, Helsinki, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Stroh GR, Dong F, Ablah E, Ward JG, Haan JM. The Impact of Methamphetamine Use on Trauma Patients at a Level I Trauma Center: A 10-Year Retrospective Review. Am Surg 2018. [DOI: 10.1177/000313481808400329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effects of methamphetamines (MAs) on trauma patient outcomes have been evaluated, but with discordant results. The purpose of this study was to identify hospital outcomes associated with MA use after traumatic injury. Retrospective review of adult trauma patients admitted to an American College of Surgeons verified–Level I trauma center who received a urine drug screen (UDS) between January 1, 2004 and December 31, 2013. Logistic regression analysis was used to identify factors associated with mortality. Patients with a negative UDS were used as controls. Among the 2321 patients included, 75.1 per cent were male, 81.9 per cent were white, and the average age was 39. Patients were grouped by UDS results (negative, MA only, other drug plus MA, or other drug without MA). A positive drug screen result of other drug without MA demonstrated a significantly lower risk for mortality, but longer intensive care unit and hospital length of stay, as well as increased ventilator days than negative results. Results of MA only did not alter the risk of mortality. These findings suggest that patients who test positive for MAs are not at an increased risk of in-hospital mortality when compared with patients having a negative drug screen.
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Affiliation(s)
- Gregory R. Stroh
- Department of Surgery, The University of Kansas School of Medicine—Wichita, Wichita, Kansas
| | - Fanglong Dong
- Western University of Health Sciences, Pomona, California
| | - Elizabeth Ablah
- Preventive Medicine and Public Health, The University of Kansas School of Medicine—Wichita, Wichita, Kansas
| | | | - James M. Haan
- Department of Surgery, The University of Kansas School of Medicine—Wichita, Wichita, Kansas
- Department of Trauma Services, Via Christi Hospital Saint Francis, Wichita, Kansas
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Darke S, Kaye S, Duflou J. Rates, characteristics and circumstances of methamphetamine-related death in Australia: a national 7-year study. Addiction 2017; 112:2191-2201. [PMID: 28603836 DOI: 10.1111/add.13897] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/10/2017] [Accepted: 06/06/2017] [Indexed: 11/28/2022]
Abstract
AIMS To (1) assess trends in the number and mortality rates of methamphetamine-related death in Australia, 2009-15; (2) assess the characteristics and the cause, manner and circumstances of death; and (3) assess the blood methamphetamine concentrations and the presence of other drugs in methamphetamine-related death. DESIGN Analysis of cases of methamphetamine-related death retrieved from the National Coronial Information System (NCIS). SETTING Australia. CASES All cases in which methamphetamine was coded in the NCIS database as a mechanism contributing to death (n = 1649). MEASUREMENTS Information was collected on cause and manner of death, demographics, location, circumstances of death and toxicology. FINDINGS The mean age of cases was 36.9 years, and 78.4% were male. The crude mortality rate was 1.03 per 100 000. The rate increased significantly over time (P < 0.001), and at 2015 the mortality rate was 1.8 [confidence interval (CI) = 1.2-2.4] times that of 2009. Deaths were due to accidental drug toxicity (43.2%), natural disease (22.3%), suicide (18.2%), other accident (14.9%) and homicide (1.5%). In 40.8% of cases, death occurred outside the major capital cities. The median blood methamphetamine concentration was 0.17 mg/l, and cases in which only methamphetamine was detected had higher concentrations than other cases (0.30 versus 0.15 mg/l, P < 0.001). The median blood methamphetamine concentration varied within a narrow range (0.15-0.20 mg/l) across manner of death. In the majority (82.8%) of cases, substances other than methamphetamine were detected, most frequently opioids (43.1%) and hypnosedatives (38.0%). CONCLUSIONS Methamphetamine death rates doubled in Australia from 2009 to 2015. While toxicity was the most frequent cause, natural disease, suicide and accident comprised more than half of deaths.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Justice Health and Forensic Mental Health Network, NSW Health, NSW, Australia
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
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Lappin JM, Darke S, Farrell M. Stroke and methamphetamine use in young adults: a review. J Neurol Neurosurg Psychiatry 2017; 88:1079-1091. [PMID: 28835475 DOI: 10.1136/jnnp-2017-316071] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/04/2017] [Accepted: 06/13/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Methamphetamine use and stroke are significant public health problems. Strokes among people aged below 45 years are much less common than in older age groups but have significant mortality and morbidity. Methamphetamine is a putative cause of strokes among younger people. METHODS A review of methamphetamine-related strokes was conducted. Bibliographic databases were searched until February 2017 for articles related to methamphetamine and stroke. Both haemorrhagic and ischaemic strokes were considered. RESULTS Of 370 articles screened, 77 were selected for inclusion. There were 81 haemorrhagic and 17 ischaemic strokes reported in case reports and series. Both types were approximately twice as common in males. Route of administration associated with haemorrhagic stroke was typically oral or injecting, but for ischaemic stroke inhalation was most common. Haemorrhagic stroke was associated with vascular abnormalities in a third of cases. One quarter of individuals completely recovered, and a third died following haemorrhagic stroke. One-fifth completely recovered, and one-fifth died following ischaemic stroke. CONCLUSIONS There is a preponderance of haemorrhagic strokes associated with methamphetamine use in young people, and methamphetamine-related stroke is associated with poor clinical outcomes. Mechanisms of methamphetamine-associated stroke include hypertension, vasculitis, direct vascular toxicity and vasospasm. In a period of rising worldwide methamphetamine use, the incidence of methamphetamine-related stroke will increase, with a consequent increase in the burden of disease contributed by such events.
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Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
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Differences in combinations and concentrations of drugs of abuse in fatal intoxication and driving under the influence cases. Forensic Sci Int 2017; 281:127-133. [DOI: 10.1016/j.forsciint.2017.10.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 11/20/2022]
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Darke S, Duflou J, Lappin J, Kaye S. Clinical and Autopsy Characteristics of Fatal Methamphetamine Toxicity in Australia. J Forensic Sci 2017; 63:1466-1471. [PMID: 29193063 DOI: 10.1111/1556-4029.13710] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/22/2022]
Abstract
Characteristics of death attributed solely to methamphetamine toxicity (MT, n = 93) by forensic pathologists were examined and compared to cases of multiple drug toxicity (MDT, n = 634). The mean age of MT cases was 36.7 years, and 86.0% were male. Strenuous activity was reported in 12.9%. The most common witness observations were: collapse (60.3%), difficulty in breathing (36.2%), and hyperthermia (27.6%). MT cases had higher blood methamphetamine (0.54 vs. 0.11 mg/L) and amphetamine (0.04 vs. 0.02 mg/L) concentrations and lower likelihoods for opioids (12.5% vs. 80.9%), hypnosedatives (27.3 vs. 60.7%), antidepressants (14.8 vs. 29.8%), and antipsychotics (9.1 vs. 19.7%). MT cases had significantly heavier hearts than MDT cases (423.4 vs. 385.8 g) and were more likely to have cardiomegaly (37.1 vs. 20.4%) and replacement fibrosis (25.7 vs. 14.5%). The clinical picture was of a sudden cardiac event in a middle-aged man with a high methamphetamine concentration. Cardiovascular signs of heavy methamphetamine use are frequently seen.
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Affiliation(s)
- Shane Darke
- National Drug& Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Johan Duflou
- National Drug& Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Julia Lappin
- National Drug& Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Sharlene Kaye
- National Drug& Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,Justice Health and Forensic Mental Health Network, NSW Health, Sydney, NSW, Australia
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Coronary artery disease, sudden death and implications for forensic pathology practice. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.mpdhp.2017.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Darke S, Duflou J, Kaye S. Prevalence and nature of cardiovascular disease in methamphetamine-related death: A national study. Drug Alcohol Depend 2017; 179:174-179. [PMID: 28787694 DOI: 10.1016/j.drugalcdep.2017.07.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Methamphetamine dependence is a major public health problem. This study examined the nature, and extent, of cardiovascular disease amongst cases of methamphetamine-related death in Australia, 2009-2015. METHODS Analysis of 894 cases of methamphetamine-related death with full autopsy reports retrieved from the National Coronial Information System. RESULTS The mean age was 37.9yrs (range 15-69yrs) and 78.5% were male. A quarter (26.3%) of cases had enlarged hearts and left ventricular hypertrophy was diagnosed in 18.9%. Severe coronary artery disease was present in 19.0%, the left coronary artery being the vessel most frequently stenosed (16.6%). Replacement fibrosis (evidence of earlier ischaemic events) in the heart muscle was observed in 19.8% of cases, and cardiomyopathy was diagnosed in 5.5%. Histological evidence of hypertension was observed in 32.7% of cases. With the exception of cardiomyopathy, equally common amongst both sexes, cardiovascular disease was more common amongst males, and those aged >35yrs. Clinically significant levels of cardiovascular disease were also observed amongst cases where the cause of death was not attributed to cardiovascular disease: cardiomegaly (19.3%), left ventricular hypertrophy (14.6%), severe coronary artery disease (9.4%), replacement fibrosis (14.4%), cardiomyopathy (3.3%). CONCLUSIONS Cardiovascular disease was highly prevalent, despite the relatively young age of cases. With methamphetamine use increasing rapidly in major regions, cardiovascular disease and cardiovascular-related death will likely increase amongst methamphetamine users.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia.
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia; Justice Health and Forensic Mental Health Network, NSW Justice Health, NSW Australia
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Darke S, Lappin J, Kaye S, Duflou J. Clinical Characteristics of Fatal Methamphetamine-related Stroke: A National Study. J Forensic Sci 2017; 63:735-739. [DOI: 10.1111/1556-4029.13620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/30/2017] [Accepted: 07/20/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Shane Darke
- National Drug & Alcohol Research Centre; University of New South Wales; NSW 2052 Australia
| | - Julia Lappin
- National Drug & Alcohol Research Centre; University of New South Wales; NSW 2052 Australia
- School of Psychiatry; University of New South Wales; NSW 2052 Australia
| | - Sharlene Kaye
- National Drug & Alcohol Research Centre; University of New South Wales; NSW 2052 Australia
- Justice Health and Forensic Mental Health Network; NSW Health; PO Box 150, Matraville NSW 2036 Australia
| | - Johan Duflou
- National Drug & Alcohol Research Centre; University of New South Wales; NSW 2052 Australia
- Sydney Medical School; University of Sydney; Sydney NSW 2006 Australia
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Zhu P, Li L, Gao B, Zhang M, Wang Y, Gu Y, Hu L. Impact of chronic methamphetamine treatment on the atherosclerosis formation in ApoE-/- mice fed a high cholesterol diet. Oncotarget 2017; 8:55064-55072. [PMID: 28903402 PMCID: PMC5589641 DOI: 10.18632/oncotarget.19020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/04/2017] [Indexed: 11/25/2022] Open
Abstract
Background We previously reported that methamphetamine could promote atherosclerosis (AS) in ApoE−/− mice fed normal chow. We herein observed the impact of methamphetamine on AS in ApoE−/− mice fed a high cholesterol diet and explored the potential mechanisms. Results and Materials and Methods Male ApoE−/− mice fed a high cholesterol diet were treated with saline (NS, n = 5) or methamphetamine [8 mg/kg/day (M8, n = 6) through intraperitoneal injection] for 24 weeks. Afterwards, the percentage area of atheromatous plaque in aortic root (44.31 ± 3.21% vs. 32.91 ± 3.58%, P < 0.01) and atherosclerotic lesion area on Oil red O stained en face aorta (32.74 ± 6.97% vs. 18.72 ± 3.65%, P < 0.01) were significantly higher in M8 group than in NS group. The percentages of Th1 cells and Th17 cells in spleen were significantly higher while the percentages of Th2 cells and CD4+CD25+Foxp3+ Tregs were significantly lower in M8 group than in NS group. mRNA expressions of TNF-α, IFN-γ, and IL-17 were significantly up-regulated, IL-4, IL-10, Foxp3, and TGF-β were significantly down-regulated in carotid artery and in spleen in M8 group compared to NS group. Conclusions Chronic methamphetamine treatment can enhance atherosclerotic plaque formation possibly through promoting proinflammatory cytokine secretions in ApoE−/− mice fed a high cholesterol diet.
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Affiliation(s)
- Pengfei Zhu
- Department of Cardiology, Heart Center at Puai Hospital, Puai Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lun Li
- Department of Cardiology, Heart Center at Puai Hospital, Puai Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Bo Gao
- Department of Cardiology, Heart Center at Puai Hospital, Puai Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mingjing Zhang
- Department of Cardiology, Heart Center at Puai Hospital, Puai Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yuting Wang
- Department of Cardiology, Heart Center at Puai Hospital, Puai Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ye Gu
- Department of Cardiology, Heart Center at Puai Hospital, Puai Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Liqun Hu
- Department of Cardiology, Heart Center at Puai Hospital, Puai Hospital, Huazhong University of Science and Technology, Wuhan 430030, China
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Clinical Characteristics, Histopathological Features, and Clinical Outcome of Methamphetamine-Associated Cardiomyopathy. JACC-HEART FAILURE 2017; 5:435-445. [DOI: 10.1016/j.jchf.2017.02.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 12/23/2022]
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Bazmi E, Mousavi F, Giahchin L, Mokhtari T, Behnoush B. Cardiovascular Complications of Acute Amphetamine Abuse: Cross-sectional study. Sultan Qaboos Univ Med J 2017; 17:e31-e37. [PMID: 28417026 DOI: 10.18295/squmj.2016.17.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/05/2016] [Accepted: 11/10/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate cardiovascular complications among patients who abuse amphetamines. METHODS This cross-sectional study took place between April 2014 and April 2015 among 3,870 patients referred to the Toxicology Emergency Department of Baharlou Hospital, Tehran University of Medical Sciences, Tehran, Iran. Those with clinical signs of drug abuse and positive urine screening tests were included in the study, while cases of chronic abuse were excluded. Cardiac complications were evaluated via electrocardiography (ECG) and transthoracic echocardiography. RESULTS A total of 230 patients (5.9%) had a history of acute amphetamine abuse and positive urine tests. Of these, 32 patients (13.9%) were <20 years old and 196 (85.2%) were male. In total, 119 (51.7%) used amphetamine and methamphetamine compounds while 111 (48.3%) used amphetamines with morphine or benzodiazepines. The most common ECG finding was sinus tachycardia (43.0%), followed by sinus tachycardia plus a prolonged QT interval (34.3%). Mean creatine kinase-MB and troponin I levels were 35.9 ± 4.3 U/mL and 0.6 ± 0.2 ng/mL, respectively. A total of 60 patients (26.1%) were admitted to the Intensive Care Unit. The majority (83.3%) of these patients had normal echocardiography results. The mean aortic root diameter (ARD) was 27.2 ± 2.8 mm. Abnormalities related to the ARD were found in 10 patients (16.7%), three of whom subsequently died. CONCLUSION According to these findings, cardiac complications were common among Iranian patients who abuse amphetamines, although the majority of patients had normal echocardiography and ECG findings.
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Affiliation(s)
- Elham Bazmi
- Department of Forensic Medicine, Legal Medicine Research Center, Tehran, Iran
| | - Farinaz Mousavi
- Department of Forensic Medicine, Legal Medicine Research Center, Tehran, Iran
| | - Leila Giahchin
- Department of Forensic Medicine, Legal Medicine Research Center, Tehran, Iran
| | - Tahmineh Mokhtari
- Department of Anatomy, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Behnoush
- Department of Forensic Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Have prohibition policies made the wrong decision? A critical review of studies investigating the effects of DMAA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 40:26-34. [DOI: 10.1016/j.drugpo.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/17/2016] [Accepted: 10/18/2016] [Indexed: 11/23/2022]
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Ezaki J, Ro A, Hasegawa M, Kibayashi K. Fatal overdose from synthetic cannabinoids and cathinones in Japan: demographics and autopsy findings. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:520-529. [PMID: 27283516 DOI: 10.3109/00952990.2016.1172594] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Sixty-one autopsy cases involving cathinones and/or cannabinoids (synthetic cathinones/cannabinoids) use have been reported. However, little is known about the demographics and autopsy findings in fatal synthetic cathinones/cannabinoids users. OBJECTIVES To elucidate demographic and autopsy findings (i.e. major organ pathology and causes of death) in synthetic cathinones/cannabinoids cases. METHODS We reviewed forensic autopsy reports in Department of Legal Medicine of Tokyo Women's Medical University (Tokyo, Japan) between 2011 and 2015 (a total of 359). We compared demographic and autopsy findings between synthetic cathinones/cannabinoids and methamphetamine cases (as control subjects). RESULTS There were 12 synthetic cathinones/cannabinoids cases and 10 methamphetamine cases. Synthetic cathinones/cannabinoids users were significantly younger than methamphetamine users (p < 0.01), and there were no cases that used both synthetic cathinones/cannabinoids and methamphetamine. Acute intoxication and cardiac ischemia were the two most prominent causes of death in both synthetic cathinones/cannabinoids users and methamphetamine users. Excited delirium syndrome and pulmonary aspiration were found only in synthetic cathinones/cannabinoids cases. CONCLUSIONS The populations of synthetic cathinones/cannabinoids and methamphetamine users who died of an overdose are different in Japan. Acute intoxication, cardiac ischemia, excited delirium syndrome, pulmonary aspiration, and drowning are the major autopsy findings in synthetic cathinones/cannabinoids-related death. Clinicians shuld be aware of these potentially fatal complications in the medical management of synthetic cathinones/cannabinoids users.
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Affiliation(s)
- Jiro Ezaki
- a Department of Legal Medicine, School of Medicine , Tokyo Women's Medical University , Tokyo , Japan
| | - Ayako Ro
- a Department of Legal Medicine, School of Medicine , Tokyo Women's Medical University , Tokyo , Japan
| | - Masayuki Hasegawa
- a Department of Legal Medicine, School of Medicine , Tokyo Women's Medical University , Tokyo , Japan
| | - Kazuhiko Kibayashi
- a Department of Legal Medicine, School of Medicine , Tokyo Women's Medical University , Tokyo , Japan
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Bugeja L, Ibrahim JE, Ferrah N, Murphy B, Willoughby M, Ranson D. The utility of medico-legal databases for public health research: a systematic review of peer-reviewed publications using the National Coronial Information System. Health Res Policy Syst 2016; 14:28. [PMID: 27067413 PMCID: PMC4828834 DOI: 10.1186/s12961-016-0096-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medico-legal death investigations are a recognised data source for public health endeavours and its accessibility has increased following the development of electronic data systems. Despite time and cost savings, the strengths and limitations of this method and impact on research findings remain untested. This study examines this issue using the National Coronial Information System (NCIS). METHODS PubMed, ProQuest and Informit were searched to identify publications where the NCIS was used as a data source for research published during the period 2000-2014. A descriptive analysis was performed to describe the frequency and characteristics of the publications identified. A content analysis was performed to identify the nature and impact of strengths and limitations of the NCIS as reported by researchers. RESULTS Of the 106 publications included, 30 reported strengths and limitations, 37 reported limitations only, seven reported strengths only and 32 reported neither. The impact of the reported strengths of the NCIS was described in 14 publications, whilst 46 publications discussed the impacts of limitations. The NCIS was reported to be a reliable source of quality, detailed information with comprehensive coverage of deaths of interest, making it a powerful injury surveillance tool. Despite these strengths, researchers reported that open cases and missing information created the potential for selection and reporting biases and may preclude the identification and control of confounders. CONCLUSIONS To ensure research results are valid and inform health policy, it is essential to consider and seek to overcome the limitations of data sources that may have an impact on results.
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Affiliation(s)
- Lyndal Bugeja
- />Health Law & Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Australia
- />Coroners Court of Victoria, 65 Kavanagh Street, Southbank, Victoria 3006 Australia
| | - Joseph E. Ibrahim
- />Health Law & Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Australia
| | - Noha Ferrah
- />Health Law & Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Australia
| | - Briony Murphy
- />Health Law & Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Australia
| | - Melissa Willoughby
- />Health Law & Ageing Research Unit, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Australia
- />Coroners Court of Victoria, 65 Kavanagh Street, Southbank, Victoria 3006 Australia
| | - David Ranson
- />Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, 3006 Australia
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Sudden cardiac death associated with premature atheroma in the young: an autopsy study emphasising single-vessel lesions. Cardiol Young 2016; 26:743-8. [PMID: 27056170 DOI: 10.1017/s1047951115001286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Aims This is the first autopsy study in the United Kingdom to analyse the demographic and pathological characteristics of atheroma associated with sudden cardiac death in young people. METHODS An observational retrospective study of referred cases of sudden cardiac death in the young (⩽35 years) associated with premature atheroma was carried out. RESULTS In total, 46 cases were referred, with a median age of 30 years (27, 32); 72% of the referred cases were male, with a mean body mass index of 30 kg/m2. Circumstances of death were as follows: at rest (n=21), exertion (n=7), in bed (n=7), related to drugs/alcohol (n=4), and unknown (n=7). A previous cardiac history was provided in 10 cases. A history of class A/B drug use was found in eight cases. There was macroscopic evidence of infarction in 10 cases (acute, n=3 and chronic, n=7). Microscopically, 10 cases demonstrated contraction band necrosis, 11 acute infarction, and 11 chronic infarction. Single-vessel disease predominated (n=28). The left anterior descending coronary artery was involved in 39/46 cases. Thrombosis was seen in 16 cases, mainly due to erosion; one case showed dual pathology with arrhythmogenic right ventricular cardiomyopathy and another showed left ventricular hypertrophy. CONCLUSIONS This study highlights premature atheroma mainly in a single vessel in young people with or without evidence of ischaemic damage in the ventricle. Dual pathology may occur. The role of arrhythmias and channelopathies are important considerations. Premature atheroma should prompt investigation for dyslipidaemias in family members.
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