Prevalence of Substance-Related Disorders in Heart Transplantation Candidates L. Sirri, L. Potena, M. Masetti, E. Tossani, F. Grigioni, C. Magelli, A. Branzi, and S. Grandi ABSTRACT Substance abuse cessation is one of the leading factors in determining the eligibility for the heart transplantation waiting list, as noncompliance with this issue may seriously endanger posttransplantation outcomes. Yet, the prevalence of substance-related disorders among candidates for heart transplantation has not been evaluated enough. Eighty three heart transplantation candidates were assessed for prior or current substance-related disorders through the Structured Clinical Interview for mental disorders according to DSM-IV. A prior history of at least one substance-related disorder was found in 64% of patients, with nicotine dependence as the most prevalent diagnosis (61.4% of the sample). Ten subjects were currently smokers, despite heart failure. A prior history of alcohol abuse and caffeine intoxication was found in 9.6% and 2.4% of patients, respectively. Substance abuse or dependence behaviors should be monitored during all the phases of heart transplantation program. Early identification of current substance-related disorders may allow better allocation of organ resources and proper lifestyle modification programs provision. A prior history of substance-related disorders should alert physicians to assess patients for possible relapse, especially after transplantation. The inclusion of a specialist in the assessment and treatment of substance-related disorders in the heart transplantation unit may reduce the risk of unsuccessful outcomes due to noncompliance with an adequate lifestyle. T HE DANGERS OF SUBSTANCE ABUSE on the cardiovascular system have been largely documented. 1,2 Cigarette smoking is one of the major causes of cardiovascular morbidity and mortality, it seems to explain about one fifth of all heart disease–related deaths. 3,4 Nicotine dependence has been found to two- to fourfold increase the risk of coronary heart disease and to double that of heart failure. Smoking has been linked with sudden cardiac death and with decreased efficacy of beta-blocking drugs in patients with myocardial infarction, through persistent sympathomimetic actions. 3–6 Detrimental hemodynamic effects of cigarette smoking have been documented in heart failure patients. 7,8 Smoking cessation results in a strong reduction in mor- tality risk from both coronary heart disease and stroke in the general population 3 and in a better prognosis among patients with myocardial infarction, with a lower reinfarc- tion risk and increased survival rates. 9 Yet, only one third to one half of patients with myocardial infarction quit or reduce cigarette smoking. 10 Some studies have documented the beneficial effects of smoking cessation programs for cardiac patients to de- crease the risk of cardiac recurrences. 11 Yet, smoking cessation programs are not routinely included in the clinical management of patients with cardiovascular disorders. 10 A relationship has been documented between life-threatening cardiovascular effects and massive intake of other sub- stances, such as caffeine, cocaine, and methamphetamine. 1,2 Excessive caffeine consumption has been related to increased systolic and diastolic blood pressure and it has been proposed to have a direct effect on cardiac mitochondria. 12,13 Although a possible cardioprotective effect of mild to moderate alcohol consumption has been suggested, the abuse of alcohol may be conducive to cardiomyopathy, hypertension, and arrhythmia. 2 Excessive alcohol intake was further associated with a greater risk of intracranial hemorrhage and ischemic stroke. 14,15 A possible detrimen- tal role of ethanol abuse on the progression of heart failure From the Department of Psychology (L.S., E.T., S.G.) and Cardiology Institute (L.P., M.M., F.G., C.M., A.B.), University of Bologna, Bologna, Italy. Address reprint requests to S. Grandi, MD, Dept of Psychol- ogy, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy. E-mail: silvana.grandi@unibo.it 0041-1345/07/$–see front matter © 2007 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2007.05.020 360 Park Avenue South, New York, NY 10010-1710 1970 Transplantation Proceedings, 39, 1970 –1972 (2007)