Drugs & Heart Diseases

Lifestyle Factors and Cardiovascular Health

Understanding lifestyle factors is crucial in assessing the risk and mitigating the impact of cardiovascular diseases. Particularly, habits such as regular physical activity, sound nutrition, weight management, and abstaining from smoking have all demonstrated significant potential to reduce the risk of cardiovascular illness.

Impact of Healthy Habits on Heart Health

Healthy lifestyle practices have a profound impact on heart health. As per NIH, in two large cohort studies, adhering to a cluster of these healthy habits resulted in a remarkable reduction in the risk of cardiovascular disease (CVD) by over 80% and diabetes by over 90%.

Particularly, lifestyle interventions such as increased physical activity and sound nutrition are key therapeutic modalities to reduce the risk of cardiovascular disease in individuals with diabetes.

However, it's noteworthy that the adoption of these healthy habits is relatively low. The American Heart Association estimates that only 5% of individuals follow all of these lifestyle factors as components of a strategy to achieve “ideal” cardiovascular health [1].

Challenges in Promoting Positive Lifestyle Changes

Despite the clear evidence supporting the benefits of a healthy lifestyle in mitigating risks related to cardiovascular diseases, promoting positive lifestyle changes remains a significant challenge. This is largely due to a multitude of factors ranging from socio-economic conditions, lack of awareness, to individual habits and preferences.

Encouraging the public to adopt and maintain these healthy habits requires sustained efforts from the medical community and various other stakeholders. Public health campaigns, educational programs, and individual counseling are some of the ways to increase awareness and promote the adoption of healthy habits.

Even though the challenges are substantial, the potential benefits of these lifestyle changes in reducing the incidence and severity of cardiovascular diseases make it a worthwhile endeavor. As the understanding of the relationship between lifestyle factors and heart diseases continues to evolve, further research and proactive measures are needed to promote healthy living habits as a preventive measure against cardiovascular diseases.

Substance Abuse and Cardiovascular Diseases

A critical aspect of understanding the link between drugs and heart diseases involves exploring how substance abuse affects cardiovascular health. This section will examine the effects of alcohol, tobacco, cocaine, and opioids on heart health.

Alcohol and Heart Health

Alcohol, when consumed in heavy amounts, poses significant risks to heart health. Heavy alcohol consumption is defined as four or more standard drinks per day for women and five or more for men. The adverse impact of heavy alcohol use on the cardiovascular system has been well documented over the last two decades [2].

Moreover, binge drinking is associated with a heightened risk of hypertension, atrial fibrillation, heart attack, sudden death, and stroke, particularly in younger individuals. Even episodic heavy drinking can be harmful to the heart [2].

Tobacco and Cardiovascular Problems

Tobacco use can lead to cardiovascular problems by damaging the heart and blood vessels, primarily through the buildup of plaque in the arteries. This plaque buildup can result in blood clots, heart attacks, strokes, or death. Tobacco use, thus, significantly contributes to the prevalence of cardiovascular diseases.

Cocaine and Heart Complications

Chronic cocaine use can lead to dysfunction of the left side of the heart, ultimately causing heart failure or defects in the heart valves. Other cardiac complications from cocaine use include disturbances in heart rhythm, inflammation of the heart muscle, and aortic ruptures.

Opioids and Cardiovascular Risk

Opioids, such as prescription pain medications and illicit opioids like heroin, can cause generalized low blood pressure, orthostatic hypotension, slow heart rate, and increased risk of heart attack, stroke, and arrhythmias. Injecting opioids increases the risk of developing endocarditis, a dangerous bacterial infection of the heart.

In conclusion, substance abuse is a significant risk factor for cardiovascular diseases. It's crucial to understand these risks and take steps to mitigate them, whether that's through professional treatment, personal lifestyle changes, or a combination of both. The dangers of substance abuse extend far beyond the immediate effects, and the impact on heart health is a prime example of this.

Drugs and Heart Diseases

The relationship between substance use and heart health is a crucial aspect of understanding the detrimental effects of drugs. This section will delve into the cardiovascular toxicity of various drugs, the effect of nicotine on the heart, and the impact of synthetic cathinones on heart health.

Cardiovascular Toxicity of Various Drugs

Substance use can have a profound effect on cardiovascular health, leading to a myriad of complications. For instance, consistent cocaine use can lead to dysfunction of the left side of the heart, ultimately causing heart failure or defects in heart valves. Other cardiac complications from cocaine use include disturbances in heart rhythm, inflammation of the heart muscle, and aortic ruptures [2].

Drugs	Cardiovascular Complications
Cocaine	Left heart dysfunction, Heart rhythm disturbances, Inflammation of the heart muscle, Aortic ruptures

Nicotine's Effect on the Heart

Nicotine, a component of tobacco, has a significant effect on the heart. Specifically, it stimulates nicotine receptors in the sympathetic nervous system ganglia and in the adrenal medulla, leading to the release of noradrenaline and adrenaline. This results in elevated blood pressure and tachycardia, or a rapid heartbeat.

Substance	Cardiovascular Effects
Nicotine	Elevated blood pressure, Tachycardia

Synthetic Cathinones and Heart Health

Synthetic cathinones, commonly sold under the guise of "bath salts," also possess significant risks for heart health. These substances can cause cardiovascular toxicity, leading to rapid heartbeat (tachycardia), high blood pressure (hypertension), heart attack (myocardial infarction), stroke, and dilated cardiomyopathy, a condition in which the heart's ability to pump blood is decreased.

Substance	Cardiovascular Effects
Synthetic Cathinones	Tachycardia, Hypertension, Myocardial infarction, Stroke, Dilated cardiomyopathy

Understanding the impact of these substances on heart health is crucial for prevention, treatment, and management of heart diseases related to substance use. Awareness about these harmful effects of drugs can aid in promoting healthier lifestyle choices, reducing the risk of heart diseases.

Medications for Cardiovascular Health

When it comes to managing cardiovascular health, especially in the context of substance-use and heart diseases, a variety of medications can play a critical role. Here we will explore four such medications: Dual Antiplatelet Therapy (DAPT), Angiotensin-Converting Enzyme (ACE) Inhibitors, Beta Blockers, and Diuretics.

Dual Antiplatelet Therapy (DAPT)

Dual Antiplatelet Therapy (DAPT) is a treatment strategy prescribed for certain individuals after heart attacks, stents placement, or coronary artery bypass graft surgery (CABG). It involves the use of two types of antiplatelet agents to prevent blood clotting. The therapy commonly includes aspirin and a P2Y12 inhibitor, with the duration of treatment varying based on the individual's condition and risk factors.

Angiotensin-Converting Enzyme (ACE) Inhibitors

Angiotensin-Converting Enzyme (ACE) inhibitors are medications designed to lower blood pressure. They achieve this by widening blood vessels, which reduces the workload of the heart. By allowing blood to flow more freely, these inhibitors can help mitigate the risk of heart attacks and strokes in individuals with high blood pressure [4].

Beta Blockers for Heart Conditions

Beta blockers, also known as Beta-adrenergic blocking agents, are another class of medications used for managing heart conditions. They work by slowing the heart rate and force of contraction, ultimately lowering blood pressure and reducing the heart's workload. This can be particularly beneficial for individuals who have experienced a heart attack or are living with heart failure [4].

Diuretics in Heart Disease Management

Diuretics, also known as water pills, contribute to heart disease management by causing the body to eliminate excess fluids and sodium through urination. By reducing fluid volume, diuretics help to lower blood pressure and reduce the heart's workload. They also aid in decreasing fluid buildup in various parts of the body, such as ankles and legs, which can be associated with heart failure.

In conclusion, medications play an essential role in managing cardiovascular health, especially in the context of substance-use and heart diseases. However, they should be used as part of a comprehensive treatment plan that includes lifestyle changes, regular monitoring, and ongoing care. Always consult with healthcare professionals before starting any new medication regimen.

Advances in Cardiovascular Research

Cardiovascular research has made significant strides, leading to the development of innovative treatments and procedures for heart diseases. The following sections explore four key advancements that are transforming cardiovascular care.

Zilebesiran: A Novel Blood Pressure Medication

Zilebesiran, a new drug in the field of cardiovascular medicine, has shown promising results in managing hypertension. It suppresses a key protein known as angiotensinogen, which plays a role in the development of hypertension. A phase I study demonstrated that Zilebesiran was safe and effective in reducing blood pressure in individuals with high blood pressure. The drug's effectiveness was notably higher at increased doses and when combined with another medication, Irbesartan. The suppression of angiotensinogen may also offer therapeutic benefits for kidney and heart diseases.

Endovascular Thrombectomy for Stroke Patients

Endovascular thrombectomy, a surgical procedure to remove blood clots from blocked arteries in the brain, has proven beneficial for even the most severe stroke patients. Numerous studies have indicated that thrombectomy outperforms standard medical treatment in improving functional independence and reducing disabilities in patients with large, severe strokes. The trials were conducted worldwide and included patients with varying stroke severities [5].

Intravascular Imaging for Stent Placement

The evolution of imaging technology has greatly enhanced the precision of stent placement in individuals with complex coronary lesions. Intravascular imaging techniques, such as intravascular ultrasonography and optical coherence tomography, offer a more comprehensive view of the artery walls and plaque than traditional angiography. Studies have indicated that using intravascular imaging to guide stent placement leads to improved outcomes and fewer complications compared to angiography guidance.

Early Use of DOACs for Stroke Patients

Direct-Acting Oral Anticoagulants (DOACs), primarily used to prevent strokes in individuals with atrial fibrillation (AFib), can be administered safely to AFib patients sooner after a stroke. Current clinical practice often delays DOAC treatment post-stroke to avoid the risk of brain bleeds. However, a study has suggested that early treatment with DOACs, initiated within 48 hours of a minor or moderate stroke, may decrease the risk of recurrent strokes and bleeding in the brain. The study utilized CT or MRI scans to determine stroke severity and identify patients who could benefit from earlier use of DOACs [5].

Illegal Drugs and Heart Disease

Illegal drugs can have significant adverse effects on cardiovascular health, leading to a variety of heart diseases and complications. This section will explore the impact of opioids, amphetamines, and marijuana on heart health, and the risks associated with injecting illegal drugs.

Impact of Opioids on Heart Health

Opioids, which include illegal drugs like heroin and synthetic opioids such as fentanyl, are highly addictive and are associated with various heart complications. Opioid-use disorder affects more than 2 million people in the United States, and in 2021, more than 80,000 people died due to opioid drug overdoses in the U.S. Using opioids through injection can lead to infective endocarditis, a serious infection of the heart lining caused by needles that are shared or dirty. Opioids are also associated with cardiac arrest.

Additionally, opioids such as morphine are sometimes used in the cardiovascular setting to reduce pain and anxiety. However, there is potential for prescribed opioids to adversely affect outcomes for patients with acute coronary syndrome. Recent data suggests that opioid use may interfere with medications used to manage and treat cardiovascular disease and stroke.

Cardiovascular Effects of Amphetamines

Amphetamines can have adverse effects on the cardiovascular system. These drugs may cause rapid heart rates, high blood pressure, and damage to the heart muscle.

Marijuana and Heart Health

Marijuana can cause an increase in heart rate and blood pressure for several hours. Over time, habitual marijuana use can increase the risk of cardiovascular diseases, particularly in people with pre-existing conditions [6].

Risks of Injecting Illegal Drugs

Injecting illegal drugs can lead to cardiovascular problems such as collapsed veins and bacterial infections of the blood vessels and heart valves. This poses serious health risks and can result in life-threatening conditions for individuals using illegal drugs.

The use of illegal drugs is a significant risk factor for heart disease, and the dangers are magnified when these substances are injected directly into the bloodstream. These findings underscore the importance of public health efforts to combat the use of illegal drugs, and emphasize the need for individuals who are struggling with substance use to seek help.