The Association of Methamphetamine Use and Cardiomyopathy in Young Patients

Yeo, Khung‐Keong; Wijetunga, Mevan; Itô, Haruo; Efird, Jimmy T.; Tay, Kevin L.; Seto, Todd B.; Alimineti, Kavitha; Kimata, Chieko; Schatz, Irwin J.

doi:10.1016/j.amjmed.2006.01.024

Cited by 148 publications

(114 citation statements)

References 15 publications

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“…In other clinical study, methamphetamine use was documented in 40% of young patients with cardiomyopathy and was more severe compared to other non-ischemic cardiomyopathies. This findings support the hypothesis that methamphetamine use may be a possible cause of unexplained cardiomyopathy in young patients because its widespread use (Yeo et al 2007). Acute and chronic cardiomyopathy from abuse is thought to be secondary to both direct cardiac toxicity and indirect amphetamine-induced hypertension, necrosis, and ischemia (Albertson et al 1999).…”

Section: Amphetamines and Metamphetaminessupporting

confidence: 80%

“…Clinically, abuse of stimulants such as cocaine, ephedrine, amphetamines or methamphetamines is associated with cardiovascular action such as tachycardia, supraventricular arrhythmias, ventricular arrhythmias, impaired conduction, hypertensive crises, acute coronary syndromes, shock and cardiac arrest. A number of cellular, animal and autopsy studies, individual case reports and case series suggested that exposures of such drugs are potentially associated with structural and functional changes of myocytes, as well as clinical manifestations of cardiomyopathy and congestive heart failure (Wijetunga et al 2003;Yeo et al 2007). The pathogenesis is probably similar to that of catecholamineinduced cardiomyopathy, i.e.…”

Section: Stimulantsmentioning

confidence: 99%

See 1 more Smart Citation

Drug-Induced Cardiomyopathies

Klimas¹

2012

Cardiomyopathies - From Basic Research to Clinical Management

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Section: Amphetamines and Metamphetaminessupporting

confidence: 80%

Section: Stimulantsmentioning

confidence: 99%

Drug-Induced Cardiomyopathies

Klimas¹

2012

Cardiomyopathies - From Basic Research to Clinical Management

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“…Toxicity is generally associated with oxidative damage, which is associated with high levels of catecholamines induced by the interaction of methamphetamine with neurotransmitter transporters, as well as with other factors such as inflammation (31). In the heart, acute methamphetamine use produces cardiac lesions whereas chronic use is associated with cardiomyopathy (32,33). We have found that although 11 C-dmethamphetamine has a high initial distribution to the heart (0.059%/cm 3 at 0.21 min after injection), its residence time in the heart is short: a half-time of approximately 0.5 min from peak.…”

Section: Discussionmentioning

confidence: 99%

PET Studies of d-Methamphetamine Pharmacokinetics in Primates: Comparison with l-Methamphetamine and ( )-Cocaine

Fowler

Kroll

Ferrieri

et al. 2007

Journal of Nuclear Medicine

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The methamphetamine molecule has a chiral center and exists as 2 enantiomers, d-methamphetamine (the more active enantiomer) and l-methamphetamine (the less active enantiomer). d-Methamphetamine is associated with more intense stimulant effects and higher abuse liability. The objective of this study was to measure the pharmacokinetics of d-methamphetamine for comparison with both l-methamphetamine and (2)-cocaine in the baboon brain and peripheral organs and to assess the saturability and pharmacologic specificity of binding. Methods: d-and l-methamphetamine and (2)-cocaine were labeled with 11 C via alkylation of the norprecursors with 11 C-methyl iodide using literature methods. Six different baboons were studied in 11 PET sessions at which 2 radiotracer injections were administered 2-3 h apart to determine the distribution and kinetics of 11 C-d-methamphetamine in brain and peripheral organs. Saturability and pharmacologic specificity were assessed using pretreatment with d-methamphetamine, methylphenidate, and tetrabenazine. 11 C-d-Methamphetamine pharmacokinetics were compared with 11 C-l-methamphetamine and 11 C-(2)-cocaine in both brain and peripheral organs in the same animal. Results: 11 C-d-and l-methamphetamine both showed high uptake and widespread distribution in the brain. Pharmacokinetics did not differ between enantiomers, and the cerebellum peaked earlier and cleared more quickly than the striatum for both. 11 C-d-Methamphetamine distribution volume ratio was not substantially affected by pretreatment with methamphetamine, methylphenidate, or tetrabenazine. Both enantiomers showed rapid, high uptake and clearance in the heart and lungs and slower uptake and clearance in the liver and kidneys. A comparison of 11 C-d-methamphetamine and 11 C-(2)-cocaine showed that 11 C-d-methamphetamine peaked later in the brain than did 11 C-(2)-cocaine and cleared more slowly. The 2 drugs showed similar behavior in all peripheral organs examined except the kidneys and pancreas, which showed higher uptake for 11 C-d-methamphetamine. Conclusion: Brain pharmacokinetics did not differ between d-and l-methamphetamine and thus cannot account for the more intense stimulant effects of d-methamphetamine. Lack of pharmacologic blockade by methamphetamine indicates that the PET image represents nonspecific binding, though the fact that methamphetamine is both a transporter substrate and an inhibitor may also play a role. A comparison of 11 C-d-methamphetamine and 11 C-(2)-cocaine in the same animal showed that the slower clearance of methamphetamine is likely to contribute to its previously reported longer-lasting stimulant effects relative to those of (2)-cocaine. High kidney uptake of d-methamphetamine or its labeled metabolites may account for the reported renal toxicity of d-methamphetamine in humans.

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“…27,33 We hypothesized that a culturally tailored intervention would be necessary and better than UC among NHOPIs with HF because NHOPIs have a unique sociocultural, linguistic, and demographic background that influences health behaviors that are fundamental to patient self-management of HF care. 11,27,[33][34][35] Interestingly, NHOPIs enrolled in this study were also clinically different compared to the general HF population as they were younger (mean age 54.4 years), had a higher BMI (mean 35.6 kg/m 2 ), a higher proportion were methamphetamine users (24%), and had a primary nonischemic cause of HF (57%). 1,[6][7][8]12 We propose that the cumulative effect of these risk factors could pose important challenges to day-to-day management of HF.…”

Section: Resultsmentioning

confidence: 99%

“…[8][9][10] Among Native Hawaiian and other Pacific Islanders (NHOPIs), methamphetamine has been associated with HF and may even represent a potentially reversible form of cardiomyopathy. 11,12 To improve the health outcomes (i.e., HF readmissions, premature CVD death, and so on) of HF patients, a number of intervention programs have been developed to provide patient-specific personalized educational information. 13,14 Several HF educational interventions have been implemented worldwide, yet there remains uncertainty as to their universal effectiveness at reducing hospital readmissions and deaths in HF patients.…”

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial to improve heart failure disparities: the Mālama Puʻuwai (caring for heart) Study

Mau¹,

Lim²,

Kaholokula³

et al. 2017

OAJCT

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Objective/Background: To conduct a randomized controlled trial to test the efficacy of a culturally tailored heart failure (HF) education program, to reduce HF hospital readmissions and/or cardiovascular disease death (HF outcomes) among Native Hawaiian and Other Pacific Islander (NHOPI) patients with HF. Methods: One hundred fifty HF patients aged ≥21 years, NHOPI race, and discharged to home were enrolled and randomized to the Mālama Puʻuwai Program (MPP) or the usual care (UC). The MPP group received a culturally tailored HF program, and the UC received similar standard HF education materials. Clinical and health behavior data were measured at baseline and 12 months. HF outcomes were monitored throughout the entire study period. Two-sample t-test, chi-square, and Cox proportional hazard modeling assessed the efficacy of intervention (MPP or UC) on HF outcomes using an intention-to-treat approach. A sensitivity post hoc analysis was performed on patients who completed the full intervention (n=127). Results: Overall, 69% were men, mean age 54.4±13.4 years, 62% were Native Hawaiian, and 24% reported methamphetamine use. More UC participants reported methamphetamine use (32% vs. 16%), hypertension (81% vs. 63%), but less myocardial infarction (27% vs. 48%). HF outcomes were higher in UC (31%) compared with MPP (19%) with higher risk for HF outcomes (hazard ratio [HR] 1.74; 95% CI: 0.89-3.40). Sensitivity post hoc analysis of intervention compliance revealed that UC was at significantly higher risk for HF outcomes than MPP (HR 2.83; 95% CI: 1.19-6.72). Conclusions: Culturally tailored HF programs have the potential to reduce HF outcomes among compliant minority patients with HF such as NHOPI.

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The Association of Methamphetamine Use and Cardiomyopathy in Young Patients

Cited by 148 publications

References 15 publications

Drug-Induced Cardiomyopathies

Drug-Induced Cardiomyopathies

PET Studies of d-Methamphetamine Pharmacokinetics in Primates: Comparison with l-Methamphetamine and ( )-Cocaine

A randomized controlled trial to improve heart failure disparities: the Mālama Puʻuwai (caring for heart) Study

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