Methamphetamine-associated PAH: First Prospective Cohort Study

Methamphetamine abuse may be overshadowed by the opioid crisis in the United States but is a deadly and growing epidemic in its own right.

The first prospective cohort study of pulmonary arterial hypertension induced by methamphetamine was condcuted at Stanford University; followed patients with Meth-PAH and idiopathic PAH (iPAH) until lung transplant, death, or January 2016 -- whichever came first.

Meth-PAH was defined as Meth use 3 or more times a week for more than 3 months; Meth-PAH was seen more commonly in men and more commonly in non-Hispanic whites. 

Meth-PAH was associated with more advanced heart failure (higher right arterial pressure, lower stroke volume index) vs iPAH and with worse prognosis. 

In California, Meth abusers had a nearly 3-fold increased risk for PAH and among users, women were at higher risk vs men.

Study limitations include the inability to identify mechanisms underlying Meth-PAH and the potential for confounding as a result of the variety of PAH therapies available during the 12-year period of the study. 

Take-home points: Meth-PAH is a severe, progressive form of PAH with worse prognosis vs iPAH; users are at increased risk for PAH vs non-users and women are at greater risk than men.