Emerging risk factors for heart failure in younger populations: A growing public health concern

Table 1 An overview of different substances of abuse and their effects on the cardiovascular system, including their associations with heart failure

Substance	Mechanism of action	Cardiovascular effects	Association with HF	Ref.
Cocaine	Blocks dopamine, norepinephrine, and serotonin reuptake	Vasoconstriction, tachycardia, arrhythmias, and hypotension	Associated with cardiomyopathy, MI, arrhythmias, and increased HF risk	[30,46]
Amphetamines	Stimulates release of norepinephrine and dopamine	Tachycardia, hypertension, cardiomyopathy	Linked to hypertensive heart disease and increased HF risk	[47,48]
Alcohol	CNS depressant altering cardiac function	Chronic use leads to alcoholic cardiomyopathy, hypertension, arrhythmias	High association with dilated cardiomyopathy leading to HF	[30,49]
Opioids	Binds to opioid receptors, decreases pain, induces euphoria	Bradycardia, hypotension, respiratory depression	Chronic use may lead to myocardial injury and increase HF risk	[48,50]
Nicotine	Increases heart rate and blood pressure	Endothelial dysfunction, tachyarrhythmias, hypertension	Increases HF risk through oxidative stress and inflammation	[49,51]
Marijuana	Activates cannabinoid receptors	Tachycardia, hypotension, changes in vascular tone	Limited evidence; potential role in MI and arrhythmias	[50,52]
Methamphetamine	Elevates dopamine release	Cardiovascular strain, hypertension	High risk of cardiomyopathy and HF due to structural remodeling	[47,52]
Synthetic cannabinoids	Potent synthetic THC, stronger than natural cannabinoids	Tachyarrhythmias, MI, blood pressure changes	Severe cardiovascular complications including HF	[50,52]
Ecstasy (MDMA)	Increases serotonin, norepinephrine, and dopamine levels	Hypertension, tachycardia, hyperthermia	Acute HF risks during dehydration and hyperthermia episodes	[51,52]
Benzodiazepines	CNS inhibition causing sedation	Hypotension, respiratory depression	Limited association with HF; can exacerbate existing conditions	[48,51]

CNS: Central nervous system; DCM: Dilated cardiomyopathy; HF: Heart failure; TCH: Tetrahydrocannabinol; MI: Myocardial infraction.