J Card Fail. 2021 Jun 13:S1071-9164(21)00216-5. doi: 10.1016/j.cardfail.2021.05.023. Online ahead of print.
Substance use is common among those with heart failure (HF) and is associated with worse clinical outcomes. Alcohol, tobacco, cannabis, and cocaine are commonly abused substances that can contribute to the development and worsening of HF. Heavy alcohol consumption can lead to dilated cardiomyopathy while moderate intake may reduce incident HF. Tobacco increases the risk of HF through coronary artery disease (CAD) and CAD independent mechanisms. Continued smoking worsens outcomes for those with HF and cessation is associated with improved risk of major adverse cardiac events. Cannabis has complex interactions on the cardiovascular system depending on the method of consumption, amount consumed, and content of cannabinoids. Delta-9-tetrahydrocannabinol (THC) can increase sympathetic tone, cause vascular dysfunction, and may increase the risk of MI. Cannabidiol (CBD) is cardioprotective in pre-clinical studies and is a potential therapeutic target. Cocaine increases sympathetic tone and is a potent proarrhythmogenic agent. It increases the risk of MI and can also lead to a dilated cardiomyopathy. Use of beta-blockers in those with HF and cocaine use is likely safe and effective. Future studies are needed to further elucidate the impact of these substances both on the development of HF and their effects on those who have HF.
Source: ncbi 2