Demographic, Hemodynamic, and HRQL Differences between Methamphetamine-Associated and Idiopathic PAH: The Pulmonary Hypertension Association Registry

Abstract

Purpose Single-center studies previously demonstrated that methamphetamine use is associated with pulmonary arterial hypertension (Meth-APAH). We sought to use the Pulmonary Hypertension Association Registry (PHAR) to compare methamphetamine-associated (Meth-APAH) to Idiopathic Pulmonary Arterial Hypertension (IPAH) in the United States. Methods PHAR is a 32-center US-based registry of 478 PAH patients new to care at a Pulmonary Hypertension Care Center. In addition to demographics and clinical parameters, baseline health-related quality of life (HRQL) is quantified by the Medical Outcomes Study Short Form-12 (SF12-PCS - generic-physical & SF12-MCS - generic-mental; higher scores denote better HRQL) and emPHasis-10 (PAH-specific; higher scores denote worse HRQL). We included adults diagnosed with Meth-APAH and, as a control group, IPAH. Differences in demographics and clinical parameters were compared by t-tests and chi-squared tests as appropriate. We tested the association of Meth-APAH and HRQL using multivariate linear regression, adjusting for age, sex, race, and education. Results Of 278 subjects included, 58 had Meth-APAH. Subjects with Meth-APAH were younger, less likely to be insured, college graduates, or married. 83% of subjects with Meth-APAH lived in the Western US. The Meth-APAH group tended to have lower cardiac index, stroke volume index, and higher right atrial pressures. The Meth-APAH group had significantly worse SF12-MCS (-3.85, 95%CI -6.48 to -1.23) and emPHasis-10 (5.79, 95%CI 1.85 to 9.74) scores compared to the IPAH group. The groups had similar SF12-PCS scores (0.79, 95%CI -1.38 to 2.96). Results were similar in incident cases (n=132, data not shown). Conclusion Meth-APAH is an aggressive phenotype most common in the Western US. It accounts for a notable proportion of PAH in PHAR centers. Routine screening for Meth-APAH is necessary, and providers should include drug rehabilitation in their therapy plan.