Recreational drinking, smoking, and drug use has been linked to premature heart disease in young people, especially young women, according to new research published in Heart.

According to the study, the number of new heart disease cases has been increasing among young adults, but the potential role of recreational substance use isn’t entirely clear. To investigate this, researchers explored whether the recreational use of tobacco, cannabis, alcohol, and illicit drugs, such as amphetamine and cocaine, might be associated with prematurely blocked arteries.

Investigators evaluated information supplied to the 2014-2015 nationwide Veterans Affairs Healthcare database and the Veterans with premaTure AtheroscLerosis (VITAL) registry. Extremely premature heart disease was defined as an event such as a heart attack, angina, or stroke before the age of 40, and premature heart disease was defined as an event before the age of 55 in men and before the age of 65 in women.

In total, there were 135,703 individuals with premature heart disease and 7716 with extremely premature heart disease. They were compared with patients who did not have premature heart disease.

According to the study, recreational use of any substance was independently associated with a higher likelihood of premature and extremely premature heart disease. Furthermore, those who regularly use 4 or more substances are 9 times as likely to be affected. The investigators also found that patients with premature heart disease were more likely to smoke (63% vs 41%), drink (32% vs 15%), and to use cocaine (13% vs 2.5%), amphetamines (3% vs 0.5%), and cannabis (12.5% vs 3%).

After accounting for potentially influential factors, such as high blood pressure, diabetes, and high cholesterol, those who smoked tobacco were nearly twice as likely to have premature heart disease whereas those who drank recreationally were 50% more likely to do so. Cocaine users were almost 2.5 times as likely to have premature heart disease, whereas amphetamine users were nearly 3 times as likely to do so. Cannabis users were more than 2.5 times likely to have premature heart disease whereas those using other drugs were approximately 2.5 times as likely to do so.

Similar trends were observed among individuals who had extremely premature heart disease, with recreational substance use associated with 1.5 to 3 times higher odds of heart disease. The associations were even stronger among women with premature and extremely premature heart disease than among similarly affected men.

Because this was an observational study, the investigators were unable to determine causality. They also acknowledged that they were unable to gather information on other potentially influential factors, such as the dose and duration of recreational substance use.

Other research has found that the use of cocaine and methamphetamine have been associated with faster cell aging and neurocognitive decline, with higher than average loss of grey matter. Epidemiological studies have also suggested that 1 in 5 young adults misuse several substances and that these polysubstance users often start at younger ages, and therefore have worse health over the long term.

The investigators said these findings demonstrate the need for better education on the potential long-term damage being done to the cardiovascular system in individuals with substance use disorders. People should be aware of the risks beyond those of an overdose and physicians should screen patients with a history of substance misuse, according to the study.

Drinking, smoking, and drug use linked to premature heart disease in the young [news release]. EurekAlert; February 15, 2021. Accessed February 18, 2021.