A study presented at the ESC Congress 2024 in London found that among 1,499 patients admitted to intensive cardiac care units in France, 11% tested positive for recent recreational drug use, which was associated with a three times higher risk of serious cardiovascular events within 1 year.
In the study, part of the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study, investigators included patients admitted over 2 weeks in April 2021 at 39 centers across France. All of the patients provided written informed consent for participation and approved urinary testing.
Among the 1,392 patients (mean age 63 years, 70% males) with complete 1-year follow-up data, 11% (n = 157) of them had an initial positive test for recreational drug use, including cannabis (9.8%), heroin and other opioids (2.3%), cocaine (1.7%), amphetamines (0.6%), and 3,4-methylenedioxymethamphetamine (MDMA) (0.6%). More than one-quarter of patients (28.7%) tested positive for two or more drugs.
After adjusting for multiple factors, recreational drug use was independently associated with a three times higher risk of serious cardiovascular events. The primary composite outcome was the occurrence of a serious cardiovascular event: cardiovascular death, nonfatal myocardial infarction (MI), or stroke. Among the 1,392 patients screened, there were 64 (4.6%) cardiovascular deaths, 24 (1.7%) nonfatal heart attacks, and 10 (0.7%) strokes.
In a subgroup analysis of 713 patients hospitalized for acute coronary syndrome at baseline, 96 (14%) had a positive recreational drug test, and 50 (7%) experienced serious cardiovascular events. The association between recreational drug use and tripled risk of serious cardiovascular events remained significant in this subgroup after adjustment for traditional prognosticators.
MDMA (4.1 times increased risk), heroin and other opioids (3.6 times), and cannabis (1.8 times) were significantly associated with serious cardiovascular events. The test deployed for each drug provided a positive or negative result, with a substantial amount required to give a positive test. The urine drug assay used in the study continued to be positive 2 to 6 days following substance use, indicating mainly recent exposure rather than regular use.
The investigators noted that despite the high rate of underreporting of recreational drug use, systematic screening is not recommended by current guidelines. They recommended that routine screening of all intensive care patients for recent recreational drug use be considered to improve risk stratification and offer personalized care to favor drug withdrawal.
The authors declared no conflicts of interest.
