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Methamphetamine and the risk of pulmonary arterial hypertension

Ramirez, Ramon L. IIIa; Perez, Vinicio De Jesusb,c; Zamanian, Roham T.b,c

Current Opinion in Pulmonary Medicine: September 2018 - Volume 24 - Issue 5 - p 416–424
doi: 10.1097/MCP.0000000000000513
DISORDERS OF THE PULMONARY CIRCULATION: Edited by Marc Humbert and Richard Channick

Purpose of review Methamphetamine is a highly addictive drug originally developed for the treatment of neuropsychiatric disorders. At present, the epidemic rise of illicit methamphetamine use has increased the number of patients living with medical complications. Our group has recently identified a definite association between methamphetamine use and pulmonary arterial hypertension (PAH), a life-threatening disease characterized by occlusive vasculopathy and progressive right heart failure. This review will discuss the evidence that links methamphetamine with PAH and how to approach the diagnosis and management of methamphetamine-associated pulmonary arterial hypertension (Meth-APAH) patients in clinic.

Recent findings Compared with idiopathic (I) PAH, Meth-APAH patients present with worse functional status, right ventricular dysfunction, and exercise tolerance. Despite therapy, the 5-year survival of Meth-APAH patients is significantly lower compared with IPAH. Genetic studies suggest that loss of function variants in genes involved in drug detoxification can increase susceptibility for methamphetamine-related vascular injury and trigger occlusive vasculopathy.

Summary PAH patients undergoing diagnostic evaluation should be screened for a history of current or past methamphetamine use. Pharmacovigilance should be implemented to monitor patients being treated with methamphetamine for neuropsychiatric disorders (e.g., attention-deficit hyperactivity disorder). More studies will be needed to identify which susceptibility factors increase risk of PAH in methamphetamine users.

aDepartment of Medicine

bDivision of Pulmonary and Critical Care Medicine, Stanford University School of Medicine

cVera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, California

Correspondence to Roham T. Zamanian, 300 Pasteur Dr, Room H3143, Stanford, CA 94305, USA. Tel: +1 650 725 5495; fax: +650 725 5489; e-mail: Zamanian@stanford.edu

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