Does methamphetamine use increase the risk of cerebrovascular accident (CVA) or stroke?

From the Guidelines

Methamphetamine use is strongly associated with an increased risk of cerebrovascular accident (CVA) or stroke, as evidenced by longitudinal data showing individuals who use methamphetamines have increased stroke risk. This association is supported by a systematic review examining misuse of prescription and other amphetamine-type stimulants, which identifies increased stroke risk (adjusted RRs of 1.6 and 3.4) and increased hemorrhagic stroke risk in former users (adjusted RR, 2.3) 1. The mechanisms underlying this increased risk include dramatic elevations in blood pressure, heart rate, and body temperature, as well as inflammation and damage to blood vessels, which can lead to both hemorrhagic strokes and ischemic strokes.

Key factors contributing to the increased stroke risk among methamphetamine users include:

• Blood vessel spasms
• Weakening of vessel walls
• Accelerated atherosclerosis (hardening of arteries)
• Formation of blood clots
• Methamphetamine-induced heart problems like arrhythmias and inflammation, which can lead to clots that travel to the brain.

It is crucial for individuals who experience stroke symptoms after methamphetamine use, such as sudden numbness, confusion, trouble speaking, vision problems, dizziness, or severe headache, to seek emergency medical care immediately, as prompt treatment is crucial for stroke outcomes. The risk applies to users of all ages, even young adults who would typically have low stroke risk 1.

From the FDA Drug Label

OVERDOSAGE Clinical Effects of Overdose Overdose of CNS stimulants is characterized by the following sympathomimetic effects: • Cardiovascular effects including tachyarrhythmias, and hypertension or hypotension. Vasospasm, myocardial infarction, or aortic dissection may precipitate sudden cardiac death. Takotsubo cardiomyopathy may develop • CNS effects including psychomotor agitation, confusion, and hallucinations. Serotonin syndrome, seizures, cerebral vascular accidents, and coma may occur.

Methamphetamine use increases the risk of cerebrovascular accident (CVA) or stroke, as evidenced by the potential for cerebral vascular accidents in the context of overdose 2.

From the Research

Methamphetamine Use and Cerebrovascular Accident (CVA) or Stroke

• Methamphetamine use has been associated with an increased risk of cerebrovascular accident (CVA) or stroke, particularly in young adults 3, 4, 5, 6.
• The evidence suggests that methamphetamine use can cause spikes in blood pressure, leading to chronic hypertension, which is a major risk factor for cerebral small vessel disease (cSVD) and stroke 3.
• Studies have shown that methamphetamine use is associated with an increased risk of hemorrhagic stroke, including hypertensive-like intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage, as well as ischemic stroke 4, 5.
• The proposed mechanisms for methamphetamine-associated stroke include hypertension, vasculitis, direct vascular toxicity, and vasospasm 4, 5, 6.
• Methamphetamine use has also been linked to cardiomyopathy, which can increase the risk of cardioembolic stroke 7.

Clinical Characteristics and Outcomes

• Methamphetamine-related strokes are often characterized by poor clinical outcomes, including high mortality and morbidity rates 4, 5.
• Patients with methamphetamine-associated stroke tend to be younger and have fewer comorbidities compared to those with non-methamphetamine-related stroke 7.
• The use of methamphetamine has been associated with a higher rate of cardiomyopathy and cardioembolic stroke in young adults 7.
• Standard therapeutic interventions for acute stroke and approaches to secondary stroke prevention seem appropriate for methamphetamine-associated strokes, with the addition of abstinence from continued methamphetamine use 4.

Epidemiological Factors

• The incidence of methamphetamine-related stroke is expected to increase with the rising worldwide use of methamphetamine 5.
• Methamphetamine use is typically more common among young adults, placing them at risk for significant drug-related harms, including stroke and Parkinson's disease 6.
• The evidence suggests that methamphetamine use is associated with a heightened risk for early-onset stroke and Parkinson's disease, particularly in young adults 6.