Abstract 4147796: Cardiovascular Manifestations of Amphetamine Misuse: A Pooled Analysis

Background: In the United States, the misuse of stimulants such as the amphetamines Adderall and Ritalin is rising. Recent data indicates that annually, about 5.1 million Americans aged 12 and older misuse these prescription medications. The literature on the cardiovascular effects of such misuse, including acute myocardial infarction (MI), cardiac arrhythmias, and catecholamine toxicity, remains limited. This first-ever pooled analysis aims to document and report the cardiovascular manifestations associated with amphetamine misuse. Methods: This study was reported in adherence to PRISMA Statement 2020 guidelines. An exhaustive literature search was conducted without language or date restrictions up to June 8th, 2024, using PubMed/Medline, Scopus, Cochrane, and Web of Science, in addition to manual hand searching following an umbrella framework. This strategy yielded 621 potential studies, with 42 undergoing full-text review. Seventeen studies met the inclusion criteria, pooling a total of 433,392 patients. SPSS V26 (IBM) was used to compute pooled counts. Results: The median age was 30 years (IQR: 11.5). Males constituted 293,798 (67.75%) and females 140,594 (32.25%). Intravenous administration was reported in 2,586 (0.60%) of cases, and oral administration in 6 (0.0014%). The mean dosage of amphetamine was 186.25 mg. The median duration of exposure was 9 years (IQR: 7.75). Hypertension was present in 218,435 (50.7%), smoking in 169,720 (39.4%), and diabetes mellitus in 112,767 (26.2%). Recreational use was reported in 431,825 (99.77%) of cases. Chronic or long-term use was seen in 2,020 (0.47%) and daily use in 32 (0.0074%). Atherosclerotic cardiovascular disease was reported in 135,703 (31.51%), ischemic heart disease in 110,823 (25.72%), and MI in 68,443 (15.89%). Clinical diagnosis methods confirmed 430,763 (99.39%) of cases. Medication management was used in 32 (0.0074%) of cases. Continued medical therapy was needed in 30 (0.007%) of cases. Mortality was reported in 499 (0.115%) of cases. Conclusion: This pooled analysis highlights the significant cardiovascular risks associated with amphetamine misuse, particularly hypertension, smoking, and diabetes. There is an urgent need for coordinated psychiatric-cardiological interventions, focusing on early detection, comprehensive addiction therapy, and managing cardiovascular health to improve patient outcomes.