Aortic dissection in young adults who abuse amphetamines

Abstract

Background: Case reports suggest a relationship between amphetamine abuse/dependence and aortic dissection, but no population-based epidemiologic studies have examined this link. Our objective was to test the hypothesis that young adults with a diagnosis of amphetamine abuse/dependence would be at higher risk for aortic dissection after accounting for known risk factors.

Methods: In this population-based case-control study of 30,922,098 discharges from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1995 to 2007, among persons aged 18 to 49 years, we identified 3,116 thoracic and thoracoabdominal aortic dissections using International Classification of Disease, Ninth Edition, Clinical Modification codes 441.01 and 441.03. The SURVEYLOGISTIC procedure in SAS 9.2 (SAS Institute, Cary, NC) was used to account for the Nationwide Inpatient Sample sampling methodology.

Results: In a multiple logistic regression analysis, while controlling for known risk factors, amphetamine abuse/dependence was significantly associated with aortic dissection (adjusted odds ratio = 3.33, 95% CI = 2.37-4.69, P < .0001).

Conclusions: This statistically significant association suggests that amphetamine abuse/dependence may play a role in aortic dissection in young adults in the United States.

Figure I

Prevalence of Amphetamine Abuse/Dependence by Year Among Patients 18 to 49 Years of Age. Footnote: in discharges of persons 18-49 years of age in Nationwide Inpatient Sample, 1995-2007.

Figure II

Incidence of Thoracic and Thoracoabdominal Aortic Dissection Per Year. Footnote: in discharges of persons 1) 18-49 years of age and 2) 50 years of age and over in Nationwide Inpatient Sample, 1995-2007.