Pathophysiology and management of recreational drug-related acute coronary syndrome: ANMCO position statement

Abstract

Recreational drug use may cause coronary artery disease through several mechanisms. An increasing number of young patients with drug-related acute coronary syndrome have been reported over recent years. The present position statement reports the most recent epidemiological data on acute coronary syndrome in the setting of drug abuse, describes the main pathophysiological mechanisms underlying coronary artery disease and acute events in these patients, and provides practical recommendations on management and an overview of prognosis.

Equation with Many Unknowns in a Young Patient with Massive Coronary Thrombus

“…It was obvious that the illegal drug/substance use was significantly associated with endothelial dysfunction and increased platelet aggregation. 4 Although randomized control studies are insufficient, current evidence and case reports in the literature show that energy drinks can cause ACS by increasing platelet aggregation and causing endothelial dysfunction in healthy young individuals without other risk factors. 9 According to the law in Türkiye, the total amount of caffeine in energy drinks is limited to not exceed 150 mg/L, inositol 100 mg/L, glucoronolactone 20 mg/L, taurine 800 mg/L.…”

The Key Role of a Psychoactive Substance Use History in Comprehensive Cardiovascular Risk Assessment, Diagnosis, Treatment, and Prevention

“…The purpose of this kind of anamnesis, in the cardiovascular field, is to gather all possible information to be able to: Identify patients who are users, whether habitual or occasional, symptomatic or not: Identification of a user is critical for cardiovascular prevention, as the withdrawal of drug use, preferably accompanied by individualized pharmacologic or non-pharmacologic therapy is demonstrated to be useful for improving the cardiovascular risk profile, preventing the onset of associated subclinical organ damage, slowing down its progression, reducing the risk and occurrence of clinically manifest disease with its possible complications, as well as the risk of recurrence of acute events [4, 5]. The benefit is not only in terms of prevention or stabilization of the clinical-instrumental picture but also regression or even complete healing of the organ damage.…”

“…The risk is significant also for occasional users or small doses, especially when there is a strong genetic predisposition [3] or other predisposing conditions. The pathogenetic mechanisms are multiple: some are direct (receptor-based) and specific to certain substances; others are indirect, mediated by the autonomic nervous system (sympathetic-adrenergic or parasympathetic stimulation) and common to the action of multiple substances or classes of substances [4]. Online Supplementary Table A (for all online suppl.…”

“…Cardiotoxic effects also vary according to the individual's age, sex, vulnerability, or genetic predisposition, as well as other objective/subjective situations contingent. In some cases, there is an increased risk (more in habitual than occasional users) of developing a real cardiopathy with an independent and added effect to that of the classic cardiovascular risk factors [1,4]. A further risk linked to drug use, especially in the case of classic drug addicts, is a poor "user health status," characterized by the presence of hygienic-environmental, psycho-attitudinal, behavioral, and socio-economic factors that negatively affect the subject's general state of health, immune defenses, adherence to treatment, but also the ease, willingness and possibility of accessing and continuing medical care.…”