Substance use may affect structural heart disease in women living with HIV, reports California study

A small study in California analyzed women living with HIV who have a history of housing instability and have used multiple substances. They found that cocaine use was associated with poorer cardiovascular health, while using cannabis appeared to mitigate some of the negative effects of stimulant use on heart health.

About This Study

“The role of substance use in structural heart disease among women living with HIV” was published online on Dec. 19, 2023, in Journal of Acquired Immune Deficiency Syndromes. The lead author is Elise D. Riley, Ph.D., of the Department of Medicine in the Division of HIV, Infectious Diseases and Global Medicine at the University of California-San Francisco School of Medicine in California.

Key Research Findings

The study evaluated the relationship between structural heart disease and substance use in 62 women living with HIV who were experiencing homelessness or unstable housing in San Francisco, California, between 2016 and 2019. Most participants were post-menopausal middle-aged women of color (69% of participants post-menopausal, average age 53 years, 48% of participants Black, 13% of participants Latinx, and 5% of participants multiracial).

Participants were interviewed, had urine collected, and underwent a transthoracic echocardiogram to assess their heart’s geometry. Substance use was confirmed by toxicology testing. Commonly used substances included tobacco (63% of participants), cannabis (52% of participants), cocaine (51% of participants), methamphetamine (29% of participants), and alcohol (26%). Methadone–a medication used to treat substance use disorder–was detected in 24% of participants.

Two indicators of an enlarged heart, concentric hypertrophy (26% of participants) and concentric remodeling (40% of participants), were positively associated with cocaine but negatively associated with cannabis. The third indicator, eccentric hypertrophy, was not associated with any of the substances studied. None of the participants took statins,medications that have been shown to reduce cardiovascular risk.

Discussion Highlights and Implications for Practice

Study limitations reported included the small sample size and the focus on women experiencing unstable housing. These findings confirm other studies indicating a detrimental effect of stimulants on left ventricular hypertrophy and remodeling, the researchers stated. In addition, they pointed out that “stimulant use has an outsized effect on cardiovascular outcomes. However, it often goes unrecognized in clinic settings.”

The authors pointed out that the fact that no women in the study were taking statins highlights another area that may need attention.

Further research is needed into the potential protective effect of cannabis use when stimulants are also used, as this study was too small to be conclusive, the researchers said. They commented that routine substance use screenings in this population could improve cardiovascular risk assessment, given that heart issues often remain undetected in women.

By Barbara Jungwirth