Highlights
- •Commonly used substances such as alcohol, tobacco, cannabis, and cocaine can lead to the development of heart failure.
- •Among those who have heart failure, continued use can worsen symptoms and increase the risk of negative outcomes and stopping can help the heart recover.
- •Cannabis, despite its reputation as a benign drug, can be problematic through its effects on blood pressure, heart rate, and medication interactions.
Abstract
Substance use is common among those with heart failure (HF) and is associated with
worse clinical outcomes. Alcohol, tobacco, cannabis, and cocaine are commonly abused
substances that can contribute to the development and worsening of HF. Heavy alcohol
consumption can lead to dilated cardiomyopathy, whereas moderate intake may decrease
incident HF. Tobacco increases the risk of HF through coronary artery disease and
coronary artery disease–independent mechanisms. Continued smoking worsens outcomes
for those with HF and cessation is associated with an improved risk of major adverse
cardiac events. Cannabis has complex interactions on the cardiovascular system depending
on the method of consumption, amount consumed, and content of cannabinoids. Delta-9-tetrahydrocannabinol
can increase sympathetic tone, cause vascular dysfunction, and may increase the risk
of myocardial infarction. Cannabidiol is cardioprotective in preclinical studies and
is a potential therapeutic target. Cocaine increases sympathetic tone and is a potent
proarrhythmogenic agent. It increases the risk of myocardial infarction and can also
lead to a dilated cardiomyopathy. The use of beta-blockers in those with HF and cocaine
use is likely safe and effective. Future studies are needed to further elucidate the
impact of these substances both on the development of HF and their effects on those
who have HF.
Key Words
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Article info
Publication history
Published online: June 13, 2021
Accepted:
May 25,
2021
Received in revised form:
May 24,
2021
Received:
May 1,
2021
Footnotes
Many commonly used substances can increase the risk of heart failure both through increasing the number of heart attacks and directly damaging the heart. Heavy alcohol use, tobacco, and cocaine are all well-established causes of heart failure and likely interact together to worsen the impact on the heart. Cessation of use can help the heart recover. Moderate alcohol use (<2 drinks per day) may decrease the rate of heart attacks, but can increase the risk of noncardiac problems. The research on cannabis is ongoing, but THC likely has a negative effect on the heart through increasing heart rate and blood pressure.
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