Associations Between Sustained Methamphetamine/Amphetamine Use and Left Ventricular Dysfunction in a Cohort of Women Living With and Without HIV.

BACKGROUND

Substance use is associated with cardiac disease, and women with HIV have a disproportionately high prevalence of substance use. However, the extent to which ongoing use of multiple substances relates to specific cardiovascular conditions in women with HIV and sociodemographically similar women without HIV ("at risk for HIV") remains understudied.

METHODS

We measured left ventricular systolic dysfunction (LVSD) and diastolic dysfunction (LVDD), conditions that precede clinical heart failure, among 1651 participants of the multisite WIHS (Women's Interagency HIV Study). Using standardized echocardiography, we determined associations between the use of substances (stimulants, opioids, tobacco, alcohol, sedatives) reported at ≥2 biannual visits ("sustained use") and left ventricular dysfunction. LVSD was defined as left ventricular ejection fraction <54%, and LVDD was considered in the absence of LVSD.

RESULTS

Most participants (75%) identified as non-Hispanic Black, the average age was 49 years, 70% had HIV, and 4.9% had LVSD. In adjusted analysis, none of the sustained substance use categories were significantly associated with LVSD. Among women without LVSD, 6.6% had LVDD. The adjusted odds of LVDD were 6.82 times higher (95% CI, 5.47-8.50) among women with sustained methamphetamine/amphetamine use. Among women with HIV only, the adjusted odds for methamphetamine/amphetamine were 5.31 (95% CI, 4.21-6.70), and adjusted odds for cigarette use were 1.87 (95% CI, 1.39-2.52).

CONCLUSIONS

In this national sample of women with and without HIV, sustained methamphetamine/amphetamine use had an especially strong association with LVDD that was independent of cigarette use. Routine assessment of methamphetamine/amphetamine use in vulnerable women may improve heart failure risk assessment.