A new study covering 100 million people links strokes with cocaine, methamphetamine, and cannabis use.

For people under 55, stroke risk nearly triples with amphetamine/methamphetamine, with cocaine not far behind.

Drug abuse is the most common predisposing condition for stroke in people under age 35.

Almost nobody gets a stroke if they’re 20, right? Stroke has been viewed for years as a disease of aging, hypertension, diabetes, hyperlipidemia, and atrial fibrillation. But when a much younger person uses illegal drugs, they may experience a stroke out of the blue.

Megan Ritson, Ph.D., and University of Cambridge colleagues just published a major study showing that illicit drugs, particularly amphetamines and cocaine, triple stroke risk in people under age 55. Cannabis has historically been considered relatively benign, but emerging evidence also suggests an important association with stroke risk. The meta-analysis found that cannabis use brought a 37 percent increase in stroke risk.

Ritson said, “This is the most comprehensive analysis ever conducted on recreational drug use and stroke risk and provides compelling evidence that drugs like cocaine, amphetamines, and cannabis are causal risk factors for stroke. These findings give us stronger evidence to guide future research and public health strategies.”

Stimulants like cocaine and methamphetamine have long been associated with acute cardiovascular complications, and now their role in cerebrovascular injury is clearly recognized. Cocaine increases stroke risks by 96 percent and amphetamines by 122 percent. Especially worrisome, stimulants can destabilize cerebral circulation in minutes. This means drug use among younger adults sometimes leads to preventable strokes. Consequently, when otherwise healthy younger patients experience ischemic or hemorrhagic stroke, substance use may be the cause.

Researchers suggest reasons why drug abuse is linked to increased stroke risks include sudden spikes in blood pressure, blood vessel spasm and constriction, heart rhythm problems, and inflammation or vasculitis. These are well-established pathways causing ischemic strokes from blood clots and hemorrhagic strokes

Methamphetamine and Amphetamine-Associated Stroke

Methamphetamine and related stimulant abuse strongly correlate with increased stroke risks. Previously reported large systematic reviews and meta-analyses show amphetamine exposure more than doubles stroke risk. In contrast to traditional vascular risk factors developing over decades, stimulant-related cerebrovascular injury may occur abruptly following drug exposure or drug-induced acute vascular stress. Patients frequently present with sudden neurologic deficits but little or no history of hypertension, diabetes, or other stroke risk factors.

Methamphetamine dramatically increases the release of dopamine and norepinephrine, resulting in tachycardia, systemic vasoconstriction, and profound blood pressure elevations. Acute hypertensive crises may rupture small intracerebral vessels or preexisting aneurysms, leading to intracerebral or subarachnoid hemorrhage. Sometimes stimulant exposure leads to reversible cerebral vasoconstriction syndrome, a condition of........

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