About 1 in 3 young patients who experienced sudden cardiac death (SCD) had either positive toxicology at the time of their death or were reported to have had frequent use of illicit drugs, with high rates of use of multiple such drugs.
Illicit drug use is thought to both accelerate underlying cardiovascular abnormalities and act as an independent risk factor for SCD, which causes half of all deaths from cardiovascular disease.
Researchers used the End Unexplained Cardiac Death (EndUCD) Registry, a prospective multisource surveillance registry combining data on all out-of-hospital cardiac arrests (OHCAs) among residents of Victoria, Australia.
The study included 523 patients older than age 18 years (median age, 43.3 years) who had died of OHCA from April 2019 to April 2021.
Drugs defined as illicit included cocaine and its metabolites, heroin and its metabolites (such as 6-monoacetylmorphine), amphetamine-type substances, cannabis, and novel psychoactive substances.
Researchers classified SCD as “coronary,” “cardiomyopathy,” “unascertained,” and “other” which included aortic dissection, pulmonary hypertension, myocarditis, and valvular disease.
Of the 523 patients eligible for inclusion in the study, 476 (91.0%) underwent autopsy, with 354 identified as nonillicit drug users and 170 patients (32.5%) as illicit drug users, 14.7% of whom used multiple drugs.
Death commonly occurred while sedentary (47.5% of patients whose circumstances were known at the time of death) or during sleep (45.8%) and was uncommon during exercise (6.7%).
Compared to nonillicit drug users, illicit drug users were more likely to be male (P = .028), smokers (P < .0001), and regular alcohol drinkers (P = .012), as well as have a lower body mass index (P = .0063) and a history of psychiatric disease (P = .002).
Causes of SCD were not significantly different between groups; coronary disease was the most common cause (43.5%) followed by unascertained (30.0%), cardiomyopathy (24.7%), and other cardiac causes (1.8%).
The finding that prevalence of illicit drug use in young patients with SCD is 50% greater than previous estimates is “provocative,” said the authors, adding this may reflect the true underreported prevalence of illicit drug use, the role of illicit drugs in contributing to SCD, or both these hypotheses.
The study was conducted by Adam Trytell, MBBS, Department of Cardiology, St Vincent’s Hospital Melbourne, Victoria, Australia, and colleagues. It was published online July 27 in Heart Rhythm.
The study lacked data on exposure period and cumulative dose of illicit drugs. There may have been patients with a history of illicit drug use and severe chronic cardiac disease among those who died suddenly but were not referred for forensic investigation. Toxicological assessment was not undertaken in a small number of patients referred for forensic investigations.
The work of the EndUCD Registry was supported for the period 2019-2022 by funds from the EndUCD Foundation. The authors have disclosed no relevant financial relationships.
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