Cardiovascular manifestations of substance abuse: part 2: alcohol, amphetamines, heroin, cannabis, and caffeine

Heart Dis. 2003 Jul-Aug;5(4):253-71. doi: 10.1097/01.hdx.0000080713.09303.a6.


The abuse of alcohol is associated with chronic cardiomyopathy, hypertension, and arrhythmia. Abstinence or using alcohol in moderation can reverse these cardiovascular problems. Alcohol is also distinguished among the substances of abuse by having possible protective effects against coronary artery disease and stroke when used in moderate amounts. Amphetamines (eg, speed, ice, ecstasy) have many of the cardiovascular toxicities seen with cocaine, including acute and chronic cardiovascular diseases. Heroin and other opiates can cause arrhythmias and noncardiac pulmonary edema, and may reduce cardiac output. Cardiovascular problems are less common with cannabis (marijuana) than with opiates, but major cognitive disorders may be seen with its chronic use. It is still controversial whether caffeine can cause hypertension and coronary artery disease, and questions have been raised about its safety in patients with heart failure and arrhythmia.

Publication types

  • Review

MeSH terms

  • Alcohol-Related Disorders / complications*
  • Alcohol-Related Disorders / physiopathology
  • Amphetamine-Related Disorders / complications*
  • Amphetamine-Related Disorders / physiopathology
  • Caffeine / adverse effects*
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / physiopathology
  • Central Nervous System Stimulants / adverse effects*
  • Heroin Dependence / complications*
  • Heroin Dependence / physiopathology
  • Humans
  • Marijuana Abuse / complications*
  • Marijuana Abuse / physiopathology


  • Central Nervous System Stimulants
  • Caffeine