J Am Heart Assoc
Meth use linked to doubled mortality after heart attack
Clinical takeaway: In younger or middle-aged patients with acute coronary syndrome, especially without typical risk factors, clinicians should consider methamphetamine use as a major cardiovascular risk marker and pair cardiac care with substance-use treatment, secondary prevention, and social support.
Acute coronary syndrome (ACS) associated with methamphetamine use appears to represent a distinct, high-risk phenotype. Patients were younger and had fewer traditional risk factors such as diabetes and high cholesterol, but they had worse long-term outcomes, including higher readmission and mortality rates.
Meth use was found in 14.8% of the more than 1,300 ACS cases reviewed. Compared with non-users, patients with methamphetamine-associated ACS had higher all-cause mortality (22.2% vs 14.4%) and more subsequent ACS admissions (42.3% vs. 27.2%). Meth use was the strongest independent predictor of all-cause mortality.
The clinical profile of meth users differed from typical atherosclerotic ACS. They were younger, with a median age of 52 vs. 57 years, and were more likely to be male. They were less likely to have diabetes and had more favorable cholesterol profiles, but they had much higher rates of cigarette smoking, alcohol use, and homelessness.
Angiography also suggested a different disease pattern. Non-obstructive coronary disease was more common with methamphetamine (24.2% vs. 10.6%) and revascularization was less common (59.3% vs. 75.0%). The authors said this may reflect mechanisms such as vasospasm, slow-flow phenomena, microvascular dysfunction, hypercoagulability, increased myocardial oxygen demand, or direct myocardial toxicity.
Researchers reviewed adults ages 18 to 65 years with ACS due to presumed type 1 myocardial infarction or unstable angina who underwent coronary angiography at Santa Clara Valley HealthCare from 2012 to 2022. The single-center design and high regional methamphetamine burden limit generalizability, and prevalence may be underestimated because not all patients were screened for methamphetamine use or underwent angiography.
“Even though meth users were generally younger and didn’t have typical cardiovascular disease-related conditions like high cholesterol, type 2 diabetes or obesity, they were twice as likely to die after a heart attack when compared to non-users,” said Susan Zhao, MD, staff cardiologist and medical director of the Coronary Care Unit at Santa Clara Valley Medical Center in San Jose, California, and associate clinical professor of medicine at Stanford School of Medicine.
Source: Zhao SX. J Am Heart Assoc. 2026 Apr 29. Methamphetamine Use Among Adult Patients Presenting With Acute Coronary Syndrome: A Single-Center Retrospective Cohort Study