Rising ‘heart infections’ tied to opioid epidemic
Pesticides up heart risk
NEW YORK, Oct 8, (RTRS): As the opioid epidemic continues in the US, more cases of an infection that damages the heart are being seen, researchers say.
Between 2002 and 2016, rates of infective endocarditis doubled, with much of the increase occurring in young, poor, white men who also tended to have higher rates of alcohol abuse, hepatitis C and HIV, the study authors report in the Journal of the American Heart Association.
“Infective endocarditis is a very serious infection ... that can lead to heart failure, valve destruction, stroke and even death,” said Dr. Serge Harb of the Cleveland Clinic’s Heart and Vascular Institute in Ohio, the study’s senior author.
The infection typically can’t be treated with antibiotics or heart surgery alone, he added. Multidisciplinary care is often needed to treat the heart, drug addiction and other complications, and the cost and time can add up quickly. Patients often need to be readmitted for subsequent episodes as well.
Vulnerable
“Patients affected are vulnerable: they are young, have low income and commonly have other serious infections,” he told Reuters Health by email. “They need help.”
Harb and colleagues analyzed data from the largest publicly available inpatient database in the US, which records information about millions of hospital stays each year. They looked at nearly 1 million cases between 2002 and 2016 that had a primary or secondary diagnosis of infective endocarditis, including about 94,000, or 10%, with a drug abuse diagnosis as well.
Nationwide during that period, the proportion of patients hospitalized with infective endocarditis who also had a diagnosis of drug abuse doubled from 8% to 16%. The increase occurred in all US regions but was greatest in the Midwest and West. Nationally, the average age of patients with infective endocarditis was 68, but among those who also had drug abuse diagnoses, it was 38.
Intravenous drug use is a particular risk factor for infective endocarditis, the study team notes.
The subset of younger patients with concurrent drug abuse was most often male, on Medicaid, and in the lowest quartile of median household income. They also more often underwent cardiac or valve surgery, had a longer stay in the hospital and higher hospitalization costs.
“Infective endocarditis related to substance abuse is a nationwide epidemic,” Harb said. “Nationwide public health measures and multidisciplinary teams are needed to address this rapidly growing nationwide problem.”
A limitation of the study, the study authors note, is that the database only provided a geographical breakdown by region rather than state or urban versus rural communities, which would be helpful in identifying clusters or “hot zones.”
Future research should look at relapse and reinfection related to treatment and surgical intervention, said Dr. Peyman Benharash of the University of California, Los Angeles, who wasn’t involved in the study.
“It’s become a huge ethical debate about reinfection of the valves and what to do,” he told Reuters Health by phone. “Do you offer a second operation?”
On-the-job exposure to high levels of pesticides might raise the risk of developing heart disease or having a stroke, according to a long-term study in Hawaii.
Farm and agricultural workers need to wear personal protective equipment and, even after they retire should continue to have their health monitored for cardiovascular complications, the authors conclude in the Journal of the American Heart Association.
“Pesticides have a long half-life and exist in the body for a long time, so side effects may appear even 10-20 years later,” said lead author Zara Berg of Fort Peck Community College in Peck, Montana.
“Many workers may not think that exposure during their younger or middle years is crucial, but it actually is,” said Berg, who worked on the study as part of her doctoral research at the University of Hawaii at Manoa in Honolulu.
For the analysis, Berg’s team used data from the Kuakini Honolulu Heart Program, established in 1965 to study heart disease in middle-aged Japanese-American men living on the island of Oahu. Participants were born between 1900 and 1919 in Japan or Hawaii and were between ages 45 and 68 at the beginning of the study. Data was updated through 1999, which allowed for up to 34 years of follow-up with surviving participants.
Berg and colleagues focused on 7,557 men who had provided information on their work history and had no heart disease at the beginning of the study period.
To gauge pesticide exposures, the research team used the Occupational Safety Health Administration exposure scale, which estimates typical pesticide amounts encountered during an eight-hour workday and 40-hour workweek based on a participant’s job, age and years worked in that industry, particularly for industrial, factory and agricultural workers.
Exposure
Berg’s team then looked at medical records to assess who developed cardiovascular disease, which they defined as coronary heart disease or a cerebrovascular incident such as a stroke.
Overall, just 451 men had high exposure to pesticides and 410 men had low-moderate exposure, while the rest had none.
After adjusting for other cardiovascular risk factors like age, weight, physical activity, alcohol and smoking, researchers found that the men with high pesticide exposure were 42% more likely than those with none to develop cardiovascular disease during the first 10 years of follow-up.
“High exposure during middle age led to cardiovascular disease sooner,” Berg noted. “Pesticides can also affect cholesterol and the concentration of heavy metals in the body.”