Young at heart? Drugs of abuse cause early-onset cardiovascular disease in the young

We are all familiar with them, from alcohol and tobacco to methamphetamine and cannabis. While drugs of abuse are often used as important medications (eg, opioids for pain management), the non-medical use of these substances has been trending upward globally,1 which is likely to be accelerated by the global coronavirus pandemic and its concomitant mental health crisis. There has been a particularly notable increase in the abuse of synthetic opioids (eg, fentanyl) and stimulants (eg, methamphetamine), with growing evidence of an epidemic of simultaneous polysubstance abuse of opioids with methamphetamine. In the USA, the emerging methamphetamine crisis has led to congressional introduction of the Methamphetamine Response Act to forestall or prevent the development of this crisis in its early stages. Since the advent of antibiotics in the early 20th century, cardiovascular disease has been the leading cause of death in the USA. While therapeutic advances have reduced the incidence of cardiovascular diseases over the past 30 years, we have recently seen an uptick in the incidence of cardiovascular disease. Although prevalent in the aged population, atherosclerotic cardiovascular diseases (ASCVDs), such as ischaemic heart disease (IHD), ischaemic cerebrovascular disease and peripheral arterial disease, have shown an alarming rise in young patients.2 However, the causal factors contributing to this premature ASCVD remain undefined. Substance use disorders have been associated with an acceleration of the ageing process. Use of cocaine and methamphetamine have been associated with accelerated cellular ageing and neurocognitive decline with greater than normal age-related cortical grey matter loss.3–5 In parallel to accelerated ageing, growing evidence suggests that the substance use disorder epidemics may accelerate vascular ageing and contribute to early-onset ASCVD. Cannabis use has been associated with accelerated cardiovascular ageing, and cardiovascular ageing has been viewed as a surrogate for organismal ageing.6 Lifetime opioid exposure predicts …