Illicit drug use and pulmonary arterial hypertension: Not so frequent

Abstract

Background: Some drugs are recognized risk factors of pulmonary arterial hypertension (PAH). Datas confirming a link between illicit drug use and PAH are limited. We tried to find out prevalence and caracteristics of PAH patients using illicit drugs in the Pulmonary Hypertension French National database. Methods: 1) A retrospective study examining the epidemiological, clinical, functional and hemodynamic caracteristics of PAH patients having reported illicit drug use in the PH French National database. 2) Prospective study with systematic questioning about illicit drug use among 131 patients without PAH risk factor. Results: In the National French database, we identified 77 patients with PAH using illicit drugs. Most consumed illicit drugs were heroin (77.9%), cocaine (46.8%) and amphetamines (18.2%). Among PAH patients, 87% had an another risk factor for PAH such as portal hypertension (post-hepatitis C cirrhosis) and/or HIV infection. Survival at 1, 3 and 5 years was 90% respectively, 80% and 72%. Only 9 patients had no identified risk factor for PAH except their illicit drug use: cocaine (90%), heroin (80%) and amphetamines (50%). No Clinical, functional and hemodynamic difference have been pointed out between patient with illicit drug use alone or associated with an another PAH risk factor. Only 4 patients among 131 PAH without risk factor asked (3%) patients have declared using illicit drugs: amphetamine (n = 2); cocaine (n = 2), heroin (n = 1). Conclusion: PAH associated with illicit drug addiction occurs mainly in patients with another risk factor for PAH (cirrhosis, HIV infection). Systematic investigation for illicit drug use in patients without favoring condition associated PAH, found a low frequency of addiction.