A few case histories have suggested that drug abuse causes pulmonary arterial hypertension (PAH), but there’s been no solid evidence—until now. Researchers in San Diego documented a strong link between PAH in adults and the chronic use of amphetamine, methamphetamine, or cocaine.

By combing the charts of every patient older than 18 years with PAH or chronic thrombolytic PAH admitted to a major San Diego hospital during an 18-month period, the research team uncovered a history of stimulant abuse in 29% of those whose PAH could not be attributed to known causes—family history, HIV, collagen vascular disease, or diet drugs.

Only 3.8% of those with a known risk factor were also stimulant users. In other words, patients with idiopathic PAH were 10 times more likely to have used stimulants than those with known causes of the condition. About half of the stimulant users had exposures lasting longer than six months to years.

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The investigators—a team of pulmonologists—concluded that substance abuse “may be a risk factor for PAH” (Chest. 2006;130: 1657-1663).