Chest
Volume 130, Issue 6, December 2006, Pages 1657-1663
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Original Research: Pulmonary Hypertension
Is Methamphetamine Use Associated With Idiopathic Pulmonary Arterial Hypertension?

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Background

Amphetamine, methamphetamine, and cocaine are suspected of being pulmonary hypertension risk factors based on a small number of case reports along with pharmacologic similarities to fenfluramine, a diet drug associated with pulmonary arterial hypertension (PAH). We sought to determine whether rates of stimulant use are increased in patients believed to have idiopathic PAH compared with patients with PAH and known risk factors and patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

In this retrospective study, rates of stimulant use were determined for 340 patients with idiopathic PAH, PAH and known risk factors, or CTEPH seen between November 2002 and April 2004. “Stimulant” use was defined as any reported use of amphetamine, methamphetamine, or cocaine. Odds of stimulant use were calculated using a polychotomous logistic regression model.

Results

A history of stimulant use was found in 28.9% of patients with a diagnosis of idiopathic PAH, compared with 3.8% of patients with PAH and a known risk factor, and 4.3% of patients with CTEPH. After adjustment for differences in age, patients with idiopathic PAH were 10.14 times (95% confidence interval, 3.39 to 30.3; p < 0.0001) more likely to have used stimulants than patients with PAH and known risk factors, and 7.63 times (95% confidence interval, 2.99 to 19.5; p < 0.0001) more likely to have used stimulants than patients with CTEPH.

Conclusions

Patients with idiopathic PAH are significantly more likely to have used stimulants than patients with other forms of pulmonary hypertension.

Section snippets

Materials and Methods

This was a retrospective study conducted at the University of California at San Diego, Thornton Hospital, La Jolla, CA. The study included all patients > 18 years old with PAH or chronic thromboembolic pulmonary hypertension (CTEPH) seen over an 18-month period (November 2002 to April 2004) in the pulmonary hypertension clinics. Information on demographics, hemodynamics, pulmonary hypertension etiology, race, and prior stimulant drug use was abstracted from medical records. Any use of

Results

Six hundred fourteen patients with a diagnosis of possible or definite pulmonary hypertension were seen over an 18-month period. One hundred eighty-three patients were excluded from the analysis because inclusion criteria were not met, including 42 patients with left-heart disease, 42 patients with lung disease, 25 patients with other forms of pulmonary hypertension, 39 patients with normal hemodynamics at catheterization, and 35 patients excluded for other reasons; additional details are given

Discussion

The central finding of this study was that methamphetamine exposure appears to be strongly associated with idiopathic PAH. Patients with idiopathic PAH were approximately 10 times more likely to have a history of stimulant use than patients with PAH and known risk factors, and almost 8 times more likely to have a history of stimulant use than patients with CTEPH, after adjustment for age. These ratios are similar to those found in studies of fenfluramine use. For example, the Surveillance of

ACKNOWLEDGMENT

We thank Cindy Morgan, MS, and Fernando Torres, MD, for assistance in statistical analysis and manuscript preparation.

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  • Cited by (0)

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    The authors have no conflicts of interest to disclose.

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