非法藥物與年輕人心臟性猝死有關

資料來源：Pauline Anderson / 2023 年 7 月 31 日 / 新聞 / Medscape 醫學新聞

大約三分之一的經歷過心源性猝死 (SCD) 的年輕患者在死亡時毒理學上呈現陽性，或者據報導經常性地使用非法藥物，其中混用多種此類藥物的使用率很高。

方法：

• 非法藥物使用被認為會加速潛在的心血管異常，並成為 心源性猝死 (SCD) 的獨立危險因素，而 SCD 導致一半的心血管疾病死亡。

• 研究人員使用了不明原因心臟死亡 (EndUCD) ［註］慈善組織之登記，這是一個前瞻性多源監測登記系統，結合了澳大利亞維多利亞州居民所有到院前心臟驟停(OHCA) 的數據。

• 該研究包括 523 名 18 歲以上（中位年齡 43.3 歲）的患者，他們於 2019 年 4 月至 2021 年 4 月期間死於 OHCA。

• 定義為非法的藥物包括可卡因及其代謝物、海洛因及其代謝物（如6-單乙酰嗎啡）、甲基安非他命類物質、大麻和新型影響精神物質。

• 研究人員將SCD 分類為「冠狀動脈」、「心肌病」、「未確定的」和「其他」，其中包括主動脈剝離、肺動脈高壓、心肌炎和瓣膜疾病。

重點：

• 在符合研究資格的523 名患者中，476 名患者（91.0%）接受了屍檢，其中354 名患者被確定為非屬非法藥物使用者，170 名患者（32.5%）為非法藥物使用者，其中14.7 % 使用多種藥物。

• 死亡通常發生在久坐時（47.5% 死亡時已知情況的患者）或睡眠時（45.8%），運動時不常見（6.7%）。

• 與非屬非法藥物使用者相比，非法藥物使用者更有可能是男性 (P = .028)、吸煙者 (P < .0001) 和經常飲酒者 (P = .012)，並且較低身體質量指數（Body Mass Index, BMI）(P = .0063) 和精神疾病史(P = .002)。

• SCD 的原因在各組之間沒有顯著差異； 冠心病是最常見的原因（43.5%），其次是未確定的原因（30.0%）、心肌病（24.7%）和其他心臟原因（1.8%）。

在實務中：

作者表示，年輕SCD 患者的非法藥物使用盛行率比之前的估計高出50%，這一發現「具有挑戰性」，並補充說，這可能真實反映了非法藥物使用盛行率的漏報，非法藥物所扮演導致SCD之角色，或者是這兩種假設。

資料來源：

該研究由澳大利亞維多利亞州墨爾本聖文森特醫院心臟病科內科醫學學士 Adam Trytell 及其同事進行。 該文章於 7 月 27 日於線上發表在《心律》雜誌上。

研究限制：

該研究缺乏非法藥物暴露時間和累積劑量的數據。 猝死者中可能有些具有吸毒史和嚴重慢性心臟病但並未轉送法醫調查的患者。 少數轉送法醫調查的患者並未進行毒理學評估。

利益衝突披露：

EndUCD 登記的工作在 2019-2022 年期間得到了 EndUCD 基金會的資金支持。 作者沒有透露任何相關的財務關係。

資料引自：寶琳·安德森。 非法藥物與年輕人心臟性猝死有關 – Medscape – 2023 年 7 月 31 日。

［註］EndUCD 是為受不明原因心臟死亡和心臟驟停影響的 50 歲以下澳大利亞人設立的國家慈善機構，代表受害者、倖存者及其家人。

Illicit Drugs Tied to Sudden Cardiac Death in Young People

Pauline Anderson / July 31, 2023 / News  /  Medscape Medical News

About 1 in 3 young patients who experienced sudden cardiac death (SCD) had either positive toxicology at the time of their death or were reported to have had frequent use of illicit drugs, with high rates of use of multiple such drugs.

METHODOLOGY:

• Illicit drug use is thought to both accelerate underlying cardiovascular abnormalities and act as an independent risk factor for SCD, which causes half of all deaths from cardiovascular disease.
• Researchers used the End Unexplained Cardiac Death (EndUCD) Registry, a prospective multisource surveillance registry combining data on all out-of-hospital cardiac arrests (OHCAs) among residents of Victoria, Australia.
• The study included 523 patients older than age 18 years (median age, 43.3 years) who had died of OHCA from April 2019 to April 2021.
• Drugs defined as illicit included cocaine and its metabolites, heroin and its metabolites (such as 6-monoacetylmorphine), amphetamine-type substances, cannabis, and novel psychoactive substances.
• Researchers classified SCD as “coronary,” “cardiomyopathy,” “unascertained,” and “other” which included aortic dissection, pulmonary hypertension, myocarditis, and valvular disease.

TAKEAWAY:

• Of the 523 patients eligible for inclusion in the study, 476 (91.0%) underwent autopsy, with 354 identified as nonillicit drug users and 170 patients (32.5%) as illicit drug users, 14.7% of whom used multiple drugs.
• Death commonly occurred while sedentary (47.5% of patients whose circumstances were known at the time of death) or during sleep (45.8%) and was uncommon during exercise (6.7%).
• Compared to nonillicit drug users, illicit drug users were more likely to be male (P = .028), smokers (P < .0001), and regular alcohol drinkers (P = .012), as well as have a lower body mass index (P = .0063) and a history of psychiatric disease (P = .002).
• Causes of SCD were not significantly different between groups; coronary disease was the most common cause (43.5%) followed by unascertained (30.0%), cardiomyopathy (24.7%), and other cardiac causes (1.8%).

IN PRACTICE:

The finding that prevalence of illicit drug use in young patients with SCD is 50% greater than previous estimates is “provocative,” said the authors, adding this may reflect the true underreported prevalence of illicit drug use, the role of illicit drugs in contributing to SCD, or both these hypotheses.

SOURCE:

The study was conducted by Adam Trytell, MBBS, Department of Cardiology, St Vincent’s Hospital Melbourne, Victoria, Australia, and colleagues. It was published online July 27 in Heart Rhythm.

LIMITATIONS:

The study lacked data on exposure period and cumulative dose of illicit drugs. There may have been patients with a history of illicit drug use and severe chronic cardiac disease among those who died suddenly but were not referred for forensic investigation. Toxicological assessment was not undertaken in a small number of patients referred for forensic investigations.

DISCLOSURES:

The work of the EndUCD Registry was supported for the period 2019-2022 by funds from the EndUCD Foundation. The authors have disclosed no relevant financial relationships.

Cite this:

Pauline Anderson. Illicit Drugs Tied to Sudden Cardiac Death in Young People – Medscape – Jul 31, 2023.