Methamphetamine-associated PAH: First Prospective Cohort Study

Veronica Hackenthal, MD

Methamphetamine abuse is on a steady rise in the US. A new study highlights the nature and dangers of Meth-PAH.

“The focus on opioids overshadows another worsening drug plague,” read the title of an article in The Economist in June 2017.1 The encroaching plague is the resurgence of methamphetamine abuse that appears to have begun in western states in the US and is moving eastward, particularly affecting rural areas.A recent study in the American Journal of Respiratory and Critical Care Medicine looked at one specific outcome of Meth abuse – Meth-associated pulmonary arterial hypertension (Meth-PAH), a severe, progressive form of PAH, with worse prognosis than idiopathic PAH (IPAH).This short slide show highglights the study and the results.Image on all slides ©style-photography/Shutterstock.com

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.

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