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Recreational substance use was associated with early-onset atherosclerotic cardiovascular disease (ASCVD) -- with risk especially high in women, according to data from the VA.

Independent predictors of premature ASCVD -- a first event before age 55 for men and 65 for women -- flagged by Salim Virani, MD, PhD, of Baylor College of Medicine in Houston, and colleagues included:

• Tobacco use (adjusted OR 1.97, 95% CI 1.94-2.00)
• Alcohol use (adjusted OR 1.50, 95% CI 1.47-1.52)
• Cocaine use (adjusted OR 2.44, 95% CI 2.38-2.50)
• Amphetamine use (adjusted OR 2.74, 95% CI 2.62-2.87)
• Cannabis use (adjusted OR 2.65, 95% CI 2.59-2.71)
• Other drug use (adjusted OR 2.53, 95% CI 2.47-2.59)

There were similar associations between recreational use of these substances and the development of extremely premature ASCVD (first event before age 40), the group .

"The association of these recreational substances with early-onset ASCVD, independent of traditional atherosclerotic risk factors or concomitant use of other drugs, emphasizes the importance of facilitating cessation among young adult users," Virani's group said.

Notably, likelihood of early-onset ASCVD climbed with each additional substance used, such that people using four or more substances had the highest risk (OR 8.85, 95% CI 8.63-9.08).

Additionally, risk differed by sex: women had stronger associations between substance use and premature ASCVD (P<0.05 for interaction), whereas men showed smaller effect sizes.

"Substance use disorders have been associated with an acceleration of the aging process," wrote Anthony Wayne Orr, PhD, and colleagues at LSU Health Shreveport, in . "We are only young once, and we should do everything in our power to maintain that state as long as we can."

The editorialists suggested a nationwide ASCVD education campaign targeting people with substance use disorders.

"In addition, clinicians and primary care providers should begin screening their adult and young adult patients with a history of a for symptoms of premature or extremely premature ASCVDs at earlier stages in their patients' lives," according to Orr's group.

Drug and alcohol screening rates may improve if guidelines started recommending screening for all people with ischemic cerebrovascular disease or peripheral artery disease on top of the current recommendation to screen acute MI patients, study authors suggested.

"Our findings also support the need for aggressive interventions in implementation and accessibility of drug cessation programs as another key element of the primary prevention of ASCVD," according to them.

The investigators performed their cross-sectional analysis using the nationwide Veterans Affairs Healthcare database and the VITAL (Veterans wIth premaTure AtheroscLerosis) registry.

Included in the study were more than a million people receiving primary care services throughout the VA Healthcare System in 2014 or 2015, among whom 135,703 had premature ASCVD.

People with premature ASCVD tended to be younger, and this group included more women, African Americans, Asian Americans, and people with BMI over 30 kg/m² compared with others.

The observational nature of the study was a major limitation, as well as the lack of data on participants' socioeconomic background and the predominantly white male cohort. In addition, Virani's team cautioned that they could not differentiate between people taking amphetamines recreationally and those prescribed them as a treatment for ADD.

"Retrospective studies are limited by the available data. While this study supports the association between substance use disorder and early-onset ASCVD, the effect of substance use frequency, dose, and duration cannot be reliably ascertained in this patient sample," Orr's group added.

"Prospective studies will ultimately be necessary to define the effects of dose and duration, to identify specific biomarkers for substance use-associated cardiovascular disease and to characterize the therapeutic window to limit these of substance use disorder," the editorialists wrote.

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