Feel-Good Club Drug Bad for the Heart

From the WebMD Archives

Dec. 18, 2000 -- There's more evidence weighing in against the popular club drug ecstasy. Recent studies have shown that ecstasy (also known by the acronym of its chemicals, MDMA) can cause long-term damage to the brain, and a new study shows it is also bad for the heart.

In a controlled laboratory setting, "we found that MDMA increased each person's heart rate and blood pressure significantly," says lead author Steven J. Lester, MD, a cardiologist at Mayo Clinic Scottsdale in Arizona. His study is published in this week's Annals of Internal Medicine.

But in a real-life situation -- with all-night dancing and use of several drugs -- the health risks escalate, especially if there is an unknown heart condition, says Lester.

"With dancing, kids are more likely to become dehydrated, which puts additional stress on the heart, increasing heart rate and blood pressure even further," Lester tells WebMD. "It is unusual for a kid to have a heart attack, but if they had unknown cardiovascular disease, they would be at increased risk." He adds that the ecstasy-associated deaths that he's aware of have involved multiple drug use.

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Lester's study involved eight healthy adults (five men and three women; average age 29) who reported that they had used the drug at least four times in the past three years. The studies took place in four weekly sessions in a carefully monitored research laboratory.

Initially, each person received varying doses of dobutamine, a drug widely used in medical settings to stimulate the heart. Researchers then performed an echocardiogram, which provides ultrasound pictures of the heart; they also measured heart rate and blood pressure. The test subjects were given different doses of MDMA over the three-week testing period and then had their heart functions measured again.

Researchers found that the dose of MDMA increased the heart rate, blood pressure, and the heart's oxygen consumption as much as the dobutamine dose did, says Lester. However, there was one striking difference: Dobutamine increased the heart muscle's ejection fraction -- its efficiency during contractions -- while MDMA did not.

"It suggests that MDMA requires the heart to use more oxygen than other stressors, like dobutamine does," Lester tells WebMD. "This puts [people who take the drug] at short-term risk for a heart event like a heart attack."

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"[This is] an interesting preliminary study," says Donna Zwas, MD, clinical director of the echocardiography lab at Thomas Jefferson University hospital in Philadelphia.

"It helps us understand what the drug does in the short term. ... It will help treat overdoses in the emergency room," she tells WebMD. "If someone's heart is going wild, you would want to slow it down and decrease cardiac output. If someone has a hidden heart problem, it would definitely cause stress on the heart, similar to extreme exercise. Dancing would have additive effects, but these are young people, and their overall cardiac risk is low ... unless there is a condition they are not aware of."

Calling Lester's study "well controlled," Stephen Holtzman, PhD, professor pf pharmacology at Emory University School of Medicine in Atlanta, tells WebMD, "There have been other studies of cardiovascular effects of MDMA ... this is not the first one. Another study done in Europe showed that blood pressure stays up for awhile, at least an hour and a half. Another study showed that blood pressure is elevated [for] two-and-a-half hours. These changes are very similar to what Lester found -- significant."

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The studies show "real implications for anyone with any kind of cardiovascular disease," Holtzman says. "If they are already hypertensive or may have angina pectoris or some other cardiac problems, the increased workload on the heart could lead to a heart attack. Increases in blood pressure may cause a stroke. Presumably, kids are in better shape physically than adults, but it's always got to be considered a risk because there might be pre-existing condition.

"The effects [with MDMA] are very similar to what you get with amphetamine ... much like with cocaine," says Holtzman. "There have been a number of reports of heart attacks and stroke in cocaine users."

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