Reverse Remodeling of Methamphetamine-Associated Cardiomyopathy: An Update on Mechanisms for Recovery

Abstract

Methamphetamine (MA) use continues to rise worldwide. The adverse effects of MA on the cardiovascular system include cardiomyopathy, dysrhythmias, coronary arterial vasospasm, and atherosclerosis. Methamphetamine-associated cardiomyopathy (MACM) affects predominantly younger male patients and is responsible for an increasing proportion of heart failure emergency department visits, hospital admissions/readmissions, morbidity, and mortality. Reverse remodeling of MACM and full cardiac recovery is achievable in patients who cease using MA and remain abstinent with self-direction, cognitive behavioral therapy, brief interventions, contingency management, motivational interviewing, and residential rehabilitation. Recovery is further enhanced by the addition of an exercise program and guideline-based pharmacotherapy for heart failure, which includes β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors. Alternative heart failure treatment with isosorbide dinitrate plus hydralazine, ivabradine, vericiguat, and omecamtiv mecarbil represent further adjuncts which may promote reverse remodeling. Antioxidant compounds such as coenzyme-Q10, omega-3 polyunsaturated fatty acids, resveratrol, and cannabidiol may aid in cardiac restoration. Diet changes, metformin and glucose control, stem cell therapy, melatonin, and sleep quality improvement are further steps on the road to recovery. In this article we review the cardiotoxicity of MA, pathogenesis of MACM, and evidence behind pharmacologic and lifestyle interventions to reverse its progression.