Methamphetamine use increases the risk of cerebral small vessel disease in young patients with acute ischemic stroke

Abstract

Methamphetamine use causes spikes in blood pressure. Chronic hypertension is a major risk factor for cerebral small vessel disease (cSVD). The aim of this study is to investigate whether methamphetamine use increases the risk of cSVD. Consecutive patients with acute ischemic stroke at our medical center were screened for methamphetamine use and evidence of cSVD on MRI of the brain. Methamphetamine use was identified by self-reported history and/or positive urine drug screen. Propensity score matching was used to select non-methamphetamine controls. Sensitivity analysis was performed to assess the effect of methamphetamine use on cSVD. Among 1369 eligible patients, 61 (4.5%) were identified to have a history of methamphetamine use and/or positive urine drug screen. Compared with the non-methamphetamine group (n = 1306), the patients with methamphetamine abuse were significantly younger (54.5 ± 9.7 vs. 70.5 ± 12.4, p < 0.001), male (78.7% vs. 54.0%, p < 0.001) and White (78.7% vs. 50.4%, p < 0.001). Sensitivity analysis showed that methamphetamine use was associated with increased white matter hyperintensities, lacunes, and total burden of cSVD. The association was independent of age, sex, concomitant cocaine use, hyperlipidemia, acute hypertension, and stroke severity. Our findings suggest that methamphetamine use increases the risk of cSVD in young patients with acute ischemic stroke.

Cardiomyopathy in patients with acute ischemic stroke and methamphetamine use: Relevance for cardioembolic stroke and outcome

“…Our cohort study corroborates previous reports on the younger and male predominance in patients with methamphetamine-associated cardiomyopathy [10, 27-29] and stroke [11, 12] . Public education and government policies are needed to increase the awareness of the major health concerns of methamphetamine use and the socioeconomic burden of methamphetamine associated disabilities [20,21].…”

“…Our cohort study corroborates previous reports on the younger and male predominance in patients with methamphetamine-associated cardiomyopathy [10,[27][28][29] and stroke [11,12] .…”

“…Currently, there were only isolated case reports suggesting the association between cardiomyopathy and cardioembolic stroke in patients with methamphetamine use [22, 23]. We have previously reported on methamphetamine abuse increasing the risk of cerebral small vessel disease in young patients with AIS [12]. That study also found a high percentage (34%) of cardioembolic stroke in patients with methamphetamine abuse.…”

“…Methamphetamine is a synthetic psychostimulant that is highly addictive [1][2]. Methamphetamine use has emerged as a major risk factor for acute ischemic stroke (AIS) in young adults worldwide in recent years [3][4][5][6][7][8][9][10][11][12].…”

“…The mechanisms by which methamphetamine causes acute ischemic stroke are unclear. Case studies and forensic analysis showed cerebral vasoconstriction, atherosclerotic stenoses, arterial dissection, vasculitis, and small vessel disease in patients with methamphetamine-associated stroke [2,6,8,12,13]. Methamphetamine use was also shown to produce a dose-dependent elevation of blood pressure and chronic hypertension [14][15].…”