Other Titles
Biobehavioral Dysregulation and Cardiovascular Burden in Lifetime Stimulant Users: A Latent Class Analysis [Title Slide]
Abstract
Stimulant use disorders are associated with cardiovascular morbidity, yet risk factors within users remain unclear. This study used latent class analysis (LCA) to identify biobehavioral dysregulation patterns and examine associations with perceived stress, stimulant use, hypertension, and comorbidity burden. Sequential associations from stress to stimulant use to hypertension were explored among individuals with high dysregulation.
We conducted a secondary analysis of NIH All of Us Research Program data from participants with lifetime stimulant use who completed surveys and had biometric and electronic health record data (N=1,480). Missing data were handled using multiple imputation. LCA identified dysregulation profiles based on sleep disorder, depression, and fatigue diagnoses. Logistic and linear regression models estimated associations between class membership and perceived stress, recent illicit stimulant use or diagnosis, hypertension, and Charlson Comorbidity Index, adjusting for age, BMI, sex, and race. Within the high dysregulation class, sequential path analysis tested associations between stress and stimulant use, and between stimulant use and hypertension. Analyses were conducted in R.
Two classes emerged: low dysregulation (75.6%, n=1,119) and high dysregulation (24.4%, n=361). High dysregulation was associated with higher perceived stress (β=3.76, 95% CI [2.84, 4.68]), hypertension (OR=3.62, 95% CI [2.74, 4.79]), and greater comorbidity burden (β=1.12, 95% CI [0.95, 1.30]). It was also associated with congestive heart failure (OR=3.15), acute myocardial infarction (OR=4.32), and cerebrovascular disease (OR=3.33). Class membership was not associated with recent illicit stimulant use (OR=1.25, p=0.154). Within the high dysregulation group, perceived stress was associated with illicit stimulant use (OR=1.048, 95% CI [1.014, 1.084]), and illicit stimulant use was associated with hypertension (OR=2.22, 95% CI [1.17, 4.36]).
One-quarter of lifetime stimulant users showed high biobehavioral dysregulation marked by co-occurring sleep disorder, depression, and fatigue. This subgroup had threefold higher hypertension and elevated cardiovascular morbidity. Among highly dysregulated users, stress was associated with illicit stimulant use, which was associated with hypertension. Findings support nurse-led screening and integrated interventions targeting stress, dysregulation, and cardiovascular risk across addiction, primary care, and cardiology settings.
Notes
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Funding. This work was supported by the National Institute of Mental Health (NIMH T32MH020061).
References:
1. All of Us Research Program Investigators. (2019). The “All of Us” Research Program. New England Journal of Medicine, 381(7), 668–676. https://doi.org/10.1056/NEJMsr1809937
2. Dominic, P., et al. (2022). Stimulant drugs and cardiac arrhythmias. Circulation: Arrhythmia and Electrophysiology, 15(1), e010273. https://doi.org/10.1161/CIRCEP.121.010273
3. Hasler, B. P., & Clark, D. B. (2020). Circadian misalignment, sleep disturbance, and substance use. Current Psychiatry Reports, 22(10), 52. https://doi.org/10.1007/s11920-020-01183-1
4. Johnson, M. W., et al. (2022). Depressive symptoms, sleep disruption, and cocaine use frequency among adults in treatment. Addictive Behaviors, 129, 107245. https://doi.org/10.1016/j.addbeh.2022.107245
5. Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders. Harvard Review of Psychiatry, 4(5), 231–244. https://doi.org/10.3109/10673229709030550
6. Pilkinton, P. D., et al. (2023). Stress-related psychiatric symptoms and nonmedical stimulant use among adults. Journal of Affective Disorders, 330, 21–29. https://doi.org/10.1016/j.jad.2023.01.030
7. Shah, R. V., et al. (2020). Association of stimulant use with adverse cardiovascular events. JAMA Network Open, 3(9), e2016898. https://doi.org/10.1001/jamanetworkopen.2020.16898
8. Sinha, P., Calfee, C. S., & Delucchi, K. L. (2021). Latent class analysis guide. Critical Care Medicine, 49(1), e63–e79. https://doi.org/10.1097/CCM.0000000000004710
9. Winiger, E. A., & Hughey, J. J. (2021). Sleep disturbance as a predictor of stimulant and cocaine use: A systematic review. Sleep Medicine Reviews, 59, 101454. https://doi.org/10.1016/j.smrv.2021.101454
10. Winhusen, T., Theobald, J., Kaelber, D. C., & Lewis, D. (2020). Depression diagnosis and the risk of stimulant and cocaine use among adults in healthcare settings. Drug and Alcohol Dependence, 212, 108002. https://doi.org/10.1016/j.drugalcdep.2020.108002
Sigma Membership
Epsilon Xi
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Secondary Analysis
Research Approach
Quantitative Research
Keywords:
Stress and Coping, Public and Community Health, Implementation Science, Central Nervous System Stimulants, Central Nervous System Stimulants--Adverse Effects
Recommended Citation
Kniffen, Wonkyung; Crane, Cory; Pezzino, Victoria; and Easton, Caroline, "Stress, Stimulant Use, and Hypertension Among Lifetime Users With High Biobehavioral Dysregulation" (2026). International Nursing Research Congress (INRC). 249.
https://www.sigmarepository.org/inrc/2026/presentations_2026/249
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-30
Stress, Stimulant Use, and Hypertension Among Lifetime Users With High Biobehavioral Dysregulation
Toronto, Ontario, Canada
Stimulant use disorders are associated with cardiovascular morbidity, yet risk factors within users remain unclear. This study used latent class analysis (LCA) to identify biobehavioral dysregulation patterns and examine associations with perceived stress, stimulant use, hypertension, and comorbidity burden. Sequential associations from stress to stimulant use to hypertension were explored among individuals with high dysregulation.
We conducted a secondary analysis of NIH All of Us Research Program data from participants with lifetime stimulant use who completed surveys and had biometric and electronic health record data (N=1,480). Missing data were handled using multiple imputation. LCA identified dysregulation profiles based on sleep disorder, depression, and fatigue diagnoses. Logistic and linear regression models estimated associations between class membership and perceived stress, recent illicit stimulant use or diagnosis, hypertension, and Charlson Comorbidity Index, adjusting for age, BMI, sex, and race. Within the high dysregulation class, sequential path analysis tested associations between stress and stimulant use, and between stimulant use and hypertension. Analyses were conducted in R.
Two classes emerged: low dysregulation (75.6%, n=1,119) and high dysregulation (24.4%, n=361). High dysregulation was associated with higher perceived stress (β=3.76, 95% CI [2.84, 4.68]), hypertension (OR=3.62, 95% CI [2.74, 4.79]), and greater comorbidity burden (β=1.12, 95% CI [0.95, 1.30]). It was also associated with congestive heart failure (OR=3.15), acute myocardial infarction (OR=4.32), and cerebrovascular disease (OR=3.33). Class membership was not associated with recent illicit stimulant use (OR=1.25, p=0.154). Within the high dysregulation group, perceived stress was associated with illicit stimulant use (OR=1.048, 95% CI [1.014, 1.084]), and illicit stimulant use was associated with hypertension (OR=2.22, 95% CI [1.17, 4.36]).
One-quarter of lifetime stimulant users showed high biobehavioral dysregulation marked by co-occurring sleep disorder, depression, and fatigue. This subgroup had threefold higher hypertension and elevated cardiovascular morbidity. Among highly dysregulated users, stress was associated with illicit stimulant use, which was associated with hypertension. Findings support nurse-led screening and integrated interventions targeting stress, dysregulation, and cardiovascular risk across addiction, primary care, and cardiology settings.
Description
LCA of 1,480 lifetime stimulant users identified a 24% subgroup with high dysregulation marked by sleep disorder, depression, and fatigue. This group had threefold higher hypertension and elevated cardiovascular morbidity. Within the high dysregulation group, stress was linked to illicit stimulant use, which was linked to hypertension. Findings support nurse-led screening and integrated interventions targeting sleep, depression, fatigue, stress, and cardiovascular risk among stimulant users.