Academic Journal
Does illicit drug use increase stroke risk? A systematic review, meta-analyses, and Mendelian randomization analysis.
| Τίτλος: | Does illicit drug use increase stroke risk? A systematic review, meta-analyses, and Mendelian randomization analysis. |
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| Συγγραφείς: | Ritson M; Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK., Markus HS; Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK., Harshfield EL; Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. |
| Πηγή: | International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2026 Jul; Vol. 21 (6), pp. 788-800. Date of Electronic Publication: 2026 Jan 21. |
| Τύπος έκδοσης: | Journal Article; Systematic Review; Meta-Analysis; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: SAGE Publications Country of Publication: United States NLM ID: 101274068 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1747-4949 (Electronic) Linking ISSN: 17474930 NLM ISO Abbreviation: Int J Stroke Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2016- : Thousand Oaks, CA : SAGE Publications Original Publication: Oxford, UK : Blackwell Pub., c2005- |
| Ιατρικοί όροι (MeSH): | Stroke*/epidemiology , Stroke*/etiology , Stroke*/genetics , Substance-Related Disorders*/complications , Substance-Related Disorders*/epidemiology , Illicit Drugs*/adverse effects, Humans ; Mendelian Randomization Analysis ; Risk Factors |
| Περίληψη: | Background: Epidemiological evidence suggests associations between substance use disorders and risk of stroke, but whether these are due to confounding or are true causal relationships remains uncertain. Aims: To meta-analyze the observational evidence on illicit substance use and stroke risk and apply Mendelian randomization (MR) to evaluate potential causal effects of substance dependence on stroke subtypes. Methods: We conducted a systematic review and meta-analysis of studies reporting associations between illicit drug use and stroke (PROSPERO registration-CRD420251053702). The meta-analysis included 32 studies comprising more than 100 million total participants across administrative, hospital-based, and population-based datasets. Pooled odds ratios (ORs) were estimated using multivariate random-effects models for ischemic and hemorrhagic subtypes. We then performed two-sample MR using genome-wide association study summary statistics to examine associations between seven drug exposures and all stroke, ischemic and hemorrhagic stroke, and ischemic stroke subtypes. Results: Meta-analysis demonstrated significant associations of cannabis (OR = 1.37, 95% confidence interval (95% CI) = 1.14-1.65), cocaine (OR = 1.96; 95% CI = 1.27-3.01), and amphetamines (OR = 2.22, 95% CI = 1.40-3.53) with increased stroke risk, while no significant association was observed for opioids. Findings for cannabis showed some heterogeneity and small-study effects. MR analyses revealed that cannabis use disorder was associated with any stroke (OR = 1.11 [1.01-1.51]) and large artery stroke (OR = 1.35, 95% CI = 1.01-1.80), and cocaine dependence was associated with cardioembolic stroke (OR = 1.08, 95% CI = 1.02-1.14) and intracerebral hemorrhage (OR = 1.38, 95% CI = 1.15-1.65). Genetically predicted substance use disorder overall was associated with any stroke (OR = 1.33, 95% CI = 1.02-1.72) and intracerebral hemorrhage (OR = 7.79, 95% CI = 3.46-17.54). Problematic and dependent alcohol use was linked to large artery and cardioembolic stroke, whereas nicotine dependence showed no significant associations. Conclusion: Our findings provide consistent observational and genetic evidence that several forms of substance misuse increase stroke risk, particularly cocaine, amphetamines, and cannabis. These findings suggest important public health implications for prevention strategies targeting substance use disorders to mitigate stroke risk. |
| Competing Interests: | Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| Contributed Indexing: | Keywords: Illicit drugs; MR analysis; meta-analysis; stroke; substance-related disorders; systematic review |
| Substance Nomenclature: | 0 (Illicit Drugs) |
| Entry Date(s): | Date Created: 20260122 Date Completed: 20260625 Latest Revision: 20260726 |
| Update Code: | 20260726 |
| PubMed Central ID: | PMC13291408 |
| DOI: | 10.1177/17474930261418926 |
| PMID: | 41566428 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1747-4949 |
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| DOI: | 10.1177/17474930261418926 |