Comprehensive Review of the Cardiovascular Risks and Pathophysiological Mechanisms of Psychoactive Substances

Psychoactive substance use, encompassing both legal (tobacco, alcohol) and illicit drugs (cocaine, methamphetamines, cannabis), poses a significant and escalating threat to global cardiovascular health. This comprehensive review explores the multifaceted impact of these substances on cardiovascular diseases (CVDs), which remain the leading cause of mortality worldwide. Through an analysis of recent literature, the review elucidates the pathophysiological mechanisms—including oxidative stress, systemic inflammation, autonomic dysregulation, and endothelial dysfunction—that mediate the cardiovascular toxicity of these substances. Acute and chronic cardiovascular risks are highlighted, encompassing myocardial infarction, arrhythmias, hypertension, cardiomyopathy, and cerebrovascular events. Particular attention is given to vulnerable populations, such as younger users and individuals with pre-existing CVDs, emphasizing the compounded risks associated with prolonged substance exposure. Additionally, the review identifies gaps in current research, especially regarding the chronic cardiovascular effects and optimal long-term management strategies for substance-induced CVDs. Evidence-based recommendations for prevention, diagnosis, and management are proposed, aiming to inform clinical practice and public health policies. By integrating pathophysiological insights with clinical evidence, this review seeks to advance understanding of substance-related cardiovascular risks and promote the development of targeted interventions to mitigate this growing global health challenge.