{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T19:04:57Z","timestamp":1779822297012,"version":"3.53.1"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Population Health and Outcomes"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The underlying cause of deaths attributed to acute stimulant (methamphetamine or cocaine) toxicity is poorly understood, although cardiovascular events are believed to contribute.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      We analyzed psychological autopsy data from acute stimulant toxicity deaths in San Francisco from 2022 to 2023. Sources included vital records, autopsies, medical records, and mixed-methods interviews with informants (eg, family and friends) who knew decedents in the year preceding death. We compared sociodemographic characteristics and cardiovascular measures (autopsy, ECG, echocardiogram, or laboratory abnormalities; diagnoses; acute care visits; symptoms) by fentanyl involvement. Age was skewed and compared with a Wilcoxon rank-sum test. Proportions were compared with \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      or Fisher exact tests. Qualitative thematic analyses identified themes related to cardiovascular health in interviews.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 101 deaths, 70 involved stimulants without opioids and 31 also involved fentanyl. Median age at death was higher among stimulant without opioids compared with fentanyl-involved decedents (58 versus 50 years;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.02). A plurality were White (44%), and 36% were Black. Most (69%) were unhoused or marginally housed. Cardiovascular conditions were identified in records among 93% of stimulant without opioids and 71% of fentanyl-involved decedents (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.01), and symptoms were reported by informants for 76% of stimulant without opioids and 52% of fentanyl-involved decedents (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.02). Specific conditions more prevalent among stimulant without opioid decedents were cardiac enlargement (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.04), coronary artery disease (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.01), prolonged QTc interval (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.03), and hypertension (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.02). Themes from 140 informant interviews included family history of cardiovascular disease, cardiovascular symptoms, comorbid conditions, reluctance to seek care, and poor health contributing to social isolation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Premortem cardiovascular conditions and symptoms were common among stimulant decedents and were more prevalent among deaths attributed to stimulants without opioids compared with those involving fentanyl. In addition to opioid overdose prevention efforts, people who use stimulants might benefit from aggressive prevention and treatment of cardiovascular disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circoutcomes.125.012683","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T09:00:06Z","timestamp":1774602006000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiovascular Conditions and Symptoms in Deaths Attributed to Acute Stimulant Toxicity"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3891-6570","authenticated-orcid":true,"given":"Phillip O.","family":"Coffin","sequence":"first","affiliation":[{"name":"Center on Substance Use and Health, San Francisco Department of Public Health, CA (P.O.C., V.M.M., Y.-S.G.C., X.L.M., M.A.M.)."},{"name":"University of California San Francisco, San Francisco, CA (P.O.C., L.N.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa M.","family":"McMahan","sequence":"additional","affiliation":[{"name":"Center on Substance Use and Health, San Francisco Department of Public Health, CA (P.O.C., V.M.M., Y.-S.G.C., X.L.M., M.A.M.)."},{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (V.M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3163-0343","authenticated-orcid":true,"given":"Yi-Shin Grace","family":"Chang","sequence":"additional","affiliation":[{"name":"Center on Substance Use and Health, San Francisco Department of Public Health, CA (P.O.C., V.M.M., Y.-S.G.C., X.L.M., M.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7102-6940","authenticated-orcid":true,"given":"Xochitl","family":"Luna Marti","sequence":"additional","affiliation":[{"name":"Center on Substance Use and Health, San Francisco Department of Public Health, CA (P.O.C., V.M.M., Y.-S.G.C., X.L.M., M.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1282-1791","authenticated-orcid":true,"given":"Marley","family":"Antolin Mu\u00f1iz","sequence":"additional","affiliation":[{"name":"Center on Substance Use and Health, San Francisco Department of Public Health, CA (P.O.C., V.M.M., Y.-S.G.C., X.L.M., M.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5784-0375","authenticated-orcid":true,"given":"Jamie Suki","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Social Welfare, University of California Berkeley (J.S.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9886-9621","authenticated-orcid":true,"given":"James","family":"Knoll","sequence":"additional","affiliation":[{"name":"SUNY Upstate Medical 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