Medically Reviewed

The Effects of Drugs and Alcohol on the Heart and Cardiovascular System

4 min read · 4 sections
The cardiovascular system, sometimes referred to as the circulatory system, delivers nutrients and oxygen to the all the cells in the body via the heart and blood vessels that run through the entire body. Arteries carry oxygenated blood away from the heart to the rest of the body and veins bring deoxygenated blood back to the heart to become re-oxygenated by the lungs.1 There are many factors that can compromise the cardiovascular system, one of them being substance misuse, which includes both drugs and alcohol.2
What you will learn:
The adverse effects that alcohol, tobacco, cocaine, opioids, and other drugs can have on the heart
Whether the damage is reversible
How treatment can help

Effects of Drug and Alcohol Misuse on the Cardiovascular System

Misusing drugs or alcohol can have a significant impact on your health and can contribute to several cardiovascular problems, including:2-7

  • Hypertension (high blood pressure). Some drugs, like cocaine, can generate dangerous and sudden high blood pressure. Other substances, such as alcohol, may cause chronic hypertension, which can lead to other health consequences, including stroke, heart failure, and kidney problems.
  • Coronary heart disease. Coronary heart disease occurs when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart because of a narrowing of blood vessels. This occurs when there is plaque buildup within the arteries. Alcohol misuse can contribute to an increase in plaque.
  • Peripheral artery disease. Peripheral artery disease (PAD), often linked to tobacco use, is caused by a buildup of plaque that reduces blood flow in the peripheral arteries—the vessels that carry blood away from the heart to other parts of the body—particularly those in the legs.
  • Cardiomyopathy. Cardiomyopathy refers to problems with the heart muscle that compromise its ability to function properly and make it harder for it to pump blood. Excessive alcohol consumption is a main cause of alcoholic cardiomyopathy, a type of non-ischemic dilated cardiomyopathy, which causes the left ventricle of the heart to stretch abnormally.
  • Endocarditis. Infective endocarditis, an inflammation of the inner lining of the heart’s chambers and valves, can be caused by injection drug use and lead to arrhythmias, blood clots, valve damage, or heart failure.
  • Arrhythmias. An arrhythmia, or an irregular heartbeat, can mean that the heart is beating too fast, too slow, or irregularly. Some stimulants, such as cocaine and methamphetamine, can initiate or perpetuate various arrhythmias, which can lead to life-threatening conditions like stroke or cardiac arrest if left untreated.
  • Stroke. A stroke happens when the brain is deprived of oxygen, either from bleeding or a blocked blood vessel. A stroke can lead to lasting brain damage, long-term disabilities, or death.
  • Heart attack. Also called a myocardial infarction, a heart attack occurs when there is an imbalance between the heart’s need for oxygen and the oxygen available to the working heart. Some drugs can cause an increased demand for oxygen in the heart, a decreased ability for the heart to supply, or both at the same time.

How Drugs and Alcohol Impact the Heart and Cardiovascular System

Impact of Alcohol on the Heart

While past research suggested that moderate alcohol consumption may have reduced the risk of heart disease, more recent studies indicate that this evidence is inconclusive.8

On the other hand, the association between heavy alcohol use and its adverse impact on the cardiovascular system has been well documented over the last 2 decades. Heavy alcohol consumption is defined as 4 or more standard drinks per day for women and 5 or more for men.2

The impact of alcohol consumption on chronic (persisting over time) and acute consequences for the cardiovascular system is largely determined by the total volume of alcohol consumed and the pattern of drinking, particularly patterns associated with episodes of heavy drinking. These adverse effects on the cardiovascular system may include:2

  • Arrhythmias.
  • Hypertension.
  • Coronary heart disease.
  • Peripheral arterial disease.
  • Cardiomyopathy.
  • Stroke.
  • Heart failure.

Alcohol’s impact on the cardiovascular system is dose dependent, and although persistent, heavy drinking increases the risk of cardiovascular disease, even episodic heavy drinking can be harmful to the heart.9 Binge drinking has been associated with a heightened risk of hypertension, atrial fibrillation (an irregular, often very rapid heartbeat), heart attack, sudden death, and, in younger individuals, stroke.2

Other studies on the adverse effects of alcohol on the cardiovascular system reveal that:2,9

  • Consistently drinking 5 or more drinks per day was linked to a significant increase in the development of heart disease.
  • There is an increased risk of heart attack in the 24 hours following the consumption of 6 or more drinks on a single occasion.
  • Heavy drinkers are 1.5 times more likely to die of a stroke than those who abstain from alcohol.

Effects of Tobacco on the Heart

Tobacco use can cause cardiovascular problems as well. When individuals breathe in cigarette smoke, their blood becomes contaminated with the smoke’s chemicals and is the distributed to the rest of the body. The chemicals in cigarette smoke can damage the heart and blood vessels. This primarily happens through the buildup of plaque (atherosclerosis)—a waxy substance comprised of cholesterol, scar tissue, calcium, fat, blood cells, and other material—in the arteries, the major blood vessels that carry blood from the heart to the rest of the body. The plaque buildup makes it more difficult for blood to move through the body and provide essential nutrients and oxygen to vital organs like the brain and heart. This can lead to blood clots, heart attack, stroke, or death.10

Some of the damage done to the heart and blood vessels due to tobacco use may be irreversible, which can lead to cardiovascular conditions including:

  • Coronary heart disease.
  • Hypertension.
  • Heart attack.
  • Stroke.
  • Aneurysms (bulging or weakening of an artery).
  • Peripheral artery disease.

Peripheral artery disease (PAD) is common for chronic cigarette smoking as is peripheral vascular disease, in which the narrowing of the blood vessels results in an insufficient blood flow to the arms, hands, legs, and feet, which can result in amputation.10

In rare but serious instances, an aneurysm can form in the aorta, the main artery exiting the heart to supply the body with blood. If an aortic aneurysm in the abdomen is not prevented, treated, or monitored, it can burst and cause sudden death.10 In fact, a history of smoking accounts for about 75% of all abdominal aortic aneurysms.11

Quitting tobacco use, however, can lower an individual’s risk of smoking-related cardiovascular disease, including:10

  • Reducing the risk of death from cardiovascular disease.
  • Slowing the progression of atherosclerosis and reducing further development of it.
  • Drastically lowering the risk of coronary heart disease.
  • Lowering the risk of death from stroke.

Effects of Cocaine on the Heart

The cardiovascular impact of cocaine misuse includes short- and long-term complications—some of which can be deadly.3 Among individuals who use cocaine and visit emergency departments, chest pain is a common complaint.12

Short-term adverse effects of cocaine misuse can lead to elevated blood pressure, profound slowing of the heart, heart attack, and coronary artery aneurysms. Cocaine forces the heart to work harder by increasing the heart rate and spiking blood pressure. At the same time, however, cocaine can cause the blood vessels around the heart to constrict, inhibiting the blood flow to the heart muscle. The combination of these effects can lead to a heart attack, and individuals who use cocaine are 7 times more likely to have a heart attack than those who do not use cocaine.3,13

Chronic cocaine use has been associated with dysfunction of the left side of the heart, which impacts the heart’s ability to push blood out to the rest of the body.3 This ultimately may lead to heart failure or cause defects in the heart valves.3

Other cardiac complications related to cocaine use include disturbances in heart rhythm, inflammation of the heart muscle, cardiomyopathy, deterioration of the ability of the heart to contract, and aortic ruptures.13,14

Regardless of the method of administration—smoking, inhalation, oral application, or injection—cocaine use can affect the heart. However, intravenous cocaine use also carries the risk of developing infective endocarditis.15

Impact of Amphetamines and Other Stimulants on the Heart

Stimulants have acute and chronic effects on the heart. This includes substances such as cocaine, mentioned above, and crystal meth and also amphetamines such as Adderall. All stimulants are associated with sympathetic nervous system activation, which increases the overall cardiac workload.16 However, misusing stimulants can cause adverse health implications on the cardiovascular system, including:17

  • Accelerated heart rate.
  • Vasoconstriction, or the narrowing of blood vessels, which can slow or block blood flow.
  • Bronchodilation, or the dilation of airways in the lungs, which puts additional stress on the heart.
  • Angina, a type of chest pain caused by reduced blood flow to the heart.
  • Heart valve disease.
  • Persistent hypertension.
  • Stroke.
  • An increased risk of heart attack.

Additionally, many individuals who misuse stimulants may misuse other substances as well, which may present additional risks to the cardiovascular system.16,17

How Opioids Affect the Heart

Opioids, such as prescription pain medications, like hydrocodone, as well as illicit opioids such as heroin, can have a wide range of effects on the heart.16

The immediate effects of opioids cause generalized low blood pressure (hypotension), orthostatic hypotension (a condition in which your blood pressure suddenly drops when you stand up from a seated or lying position), fainting, and slow heart rate.16

Misusing prescription opioids—taking them at higher doses or mixing them with other substances, such as alcohol or other central nervous system (CNS) depressants—can slow heart rate to dangerous levels (as well as slow or stop breathing).18

Chronic opioid use is also associated with an increased risk of heart attack, stroke, and arrythmias.16 Additionally, injecting opioids increases the risk of developing endocarditis, a dangerous bacterial infection of the heart.15 Furthermore, having repeat episodes of endocarditis raises the likelihood of having a heart attack or stroke.19

Effects of Marijuana on the Heart

Misusing marijuana, or cannabis, may have a variety of effects on the heart. While evidence indicates that an elevated heart rate and blood pressure may be some of the short-term and immediate effects associated with marijuana use, the role cannabis plays in more serious and long-term heart conditions is still unclear.16,20

The available evidence from current studies is not overwhelmingly supportive of marijuana-induced cardiovascular risk for the general population. Many of the adults who reported heart problems associated with marijuana use already had existing cardiovascular conditions and diseases. Some research suggests that chronic marijuana use may increase the risk of heart attack, arrhythmia, stroke, and cardiomyopathy for individuals with pre-existing heart problems.16

Can Alcohol- and Drug-Induced Cardiovascular Changes Be Reversed?

Stopping drug and alcohol use can improve an individual’s overall health. While not all substance-related cardiac changes are reversible, quitting drug and alcohol use can improve cardiac functioning and prevent conditions from worsening.7,21

When an individual stops drinking alcohol, cardiovascular function can significantly improve. In fact, even a significant decrease in alcohol consumption can elicit improvement.7

For individuals who smoke cigarettes, quitting drastically reduces the risk of catastrophic cardiac events. For instance, 4 years after stopping tobacco use, a person’s risk of stroke drops to the same level as those who have never smoked.10

Additionally, stopping methamphetamine use can improve heart function and symptoms for individuals who developed meth-induced cardiomyopathy.21

Furthermore, heart infections caused by injection drug use can significantly improve following treatment and sustained abstinence.6

It’s Never Too Late to Get Help

Substance misuse and addiction can have serious short- and long-term consequences on your health, but recovery is possible, and it’s never too late to seek treatment. Getting proper treatment can help end substance use and misuse, which, among other things, can lower your risk of developing cardiac issues and potentially improving conditions that may have occurred as a result of substance use.

If you or a loved one want to stop using alcohol or drugs, call us 24/7 at American Addiction Centers (AAC) at . Speak to one of our compassionate and knowledgeable admissions navigators, who can listen to your story, answer your questions, explain your options, verify your insurance (or you can fill out the form above), and get you started on your path to recovery at one of our treatment facilities.

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