Substance Use Disorder and Heart Health: Are You at Risk?

When one considers the typical lifestyle factors that contribute to heart disease such as poor diet, lack of exercise and poor sleep, substance misuse is usually not top-of-mind. But perhaps it should be.

Drug use (including nicotine, alcohol, and prescription and illicit drugs) can actually be even more dangerous to overall cardiovascular health and in some cases, cause permanent harm to one’s heart.

Heart disease is currently the leading cause of death worldwide for both men and women of all races. As of 2018, 30.3 million U.S. adults were diagnosed with heart disease and in 2020, the Centers for Disease Control and Prevention (CDC) reported that heart disease was responsible for the loss of more than 695,000 American lives, representing 20.6 percent of total deaths.  Not surprisingly, those who have a substance use disorder are at an even greater risk of severe cardiovascular health issues because these dangers increase when the body is exposed to addictive substances repeatedly over a long period of time. Yet, the numbers for substance misuse and addiction are nearly as staggering.

Approximately 31.9 million adults in the U.S. are current illegal drug users (meaning that they’ve used  within the last 30 days). Fifty-three million adults, or 19.4 percent, have misused illegal or prescription drugs within the last year. And, when alcohol and tobacco are included, 165 million (or a staggering 60.2 percent) of American adults currently misuse drugs.

So, what does this mean relative to heart health? Lots, when you consider that these substances all greatly increase the risk of cardiovascular diseases, the secondary conditions that contribute to poor cardiovascular health, and death.

How smoking affects the heart

Cigarette smoking is a major cause of cardiovascular disease. In fact, one out of every five smoking-related deaths are caused by heart disease. Cigarette smokers (and there are many of them; 34.1 million adults in the U.S. currently smoke cigarettes) are two to four times more likely to get heart disease than non-smokers. Smoking also doubles a person’s risk for stroke. And, women over 35 who take birth control pills are particularly vulnerable, as they are at much greater risk for heart disease and stroke.

Cigarette smoke inflicts its damage through chemicals that cause blood vessels to become inflamed and swollen, creating a narrowing of these vessels that can lead to numerous conditions, including atherosclerosis, coronary heart disease, heart attack, stroke and peripheral artery disease, among others.

The good news is, while smoking damages the heart and blood vessels quickly, the damage is repaired for most smokers relatively quickly as well once they quit. For example, within a year of stopping, one’s heart attack risk drops dramatically. Within five years, most smokers cut their risk of stroke to nearly that of a non-smoker.

There are many anecdotal accounts of smokers who want to quit but find it difficult to do so on their own. That’s why enlisting the assistance of a professional can be a life-saver – literally.      

How alcohol affects the heart

Alternatively, there has been heated debate over whether or not low-to-moderate alcohol consumption may actually help reduce some cardiovascular disorders, including stroke. Recently though, the World Heart Federation (WHF) released a policy brief recommending that, “no amount of alcohol is good for your heart.”

Without a doubt, alcohol intake has complex effects on cardiovascular health, something that the 14.8 million (or 10.6 percent) of U.S. adults with an alcohol use disorder should heed. Alcohol misuse and addiction is responsible for numerous contributors to heart attack, including atherosclerosis, blood clots and abnormal heart rhythms. An increased risk of Atrial Fibrillation (Afib) and congestive heart failure, as well as the development of risk factors for hypertension and hemorrhages in the blood vessels of the brain, are all consequences of alcohol addiction.

Excessive or binge drinking (the consumption of four or more drinks for women, or five or more drinks for men within a two-hour period) can have deleterious effects on blood pressure. And heavy drinking poses serious cardiovascular health risks as well, including diseases of the heart muscle known as cardiomyopathy.

Although alcohol is a depressant, it temporarily increases blood pressure and heart rate. Both return to normal when the effects of alcohol wear off, except in the case of chronic drinkers. Instead, heart rate and blood pressure remain elevated, significantly raising the probability of heart disease.

How opioids affect the heart

Many popularly misused illegal and prescription drugs also have significant negative effects on the cardiovascular system, which can range from mild to fatal.

Different drugs affect cardiovascular health differently.  For example:

• Stimulants like cocaine, one of the most widely used psychostimulants, presents unique cardiovascular risks to the 25.4 percent of illegal drug users with a drug use disorder who favor them. These types of drugs have a nearly immediate effect on the heart. Within moments after taking the drug, heart rate increases, capillaries and blood vessels begin to narrow, and the heart is tasked to pump harder. This process can lead to fatal outcomes, as increased blood pressure and the excess stress on the heart can result in a tear in the aorta, a condition that can be life-threatening.  In fact, according to researchers, cocaine is often referred to as “the perfect heart attack drug.”  And studies have shown that the effects of stimulants like cocaine on the cardiovascular system last long after its affects on the brain have faded.

• Like all psychostimulants, opioids pose grave health risks to even casual misusers. But the effects of these drugs on the cardiovascular system are opposite to those of stimulants. Opioids suppress “fight or flight” reactions in the cardiovascular system and instead, promote what is known as “reset and repair” (parasympathetic) signaling, resulting in abnormally low blood pressure (hypotension), slowed heart rate (bradycardia), and an irregular heartbeat.

Long-term misuse of opioids also damages the heart’s electrical system, which can lead to a heightened risk for coronary artery disease, and is linked to a range of other serious and potentially heart-damaging conditions ranging from hardening of the arteries to congestive heart disease.

Substance use disorder is extremely difficult for anyone to overcome alone. Many of the cardiovascular-related diseases that are a consequence of addiction may lead to death if a person is unaware that their substance use disorder is damaging one of the most important organs in their body. But it takes more to help break this vicious cycle than simply understanding the dangers of addiction. Reaching out for help, either through your employer, community or healthcare provider, will set you on the path to a healthier life. And, your heart will thank you for it!

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