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Editorials |

New Risks for Pulmonary Hypertension: Need for a Large Epidemiologic Study

Elisabeth D. Willers, MD; John H. Newman, MD
Author and Funding Information

Affiliations: Nashville, TN
 ,  Drs. Willers and Newman are affiliated with the Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine.

Correspondence to: Elisabeth D. Willers, MD, VUMC T1218 Medical Center North, Nashville, TN 37232-2650; e-mail: elisabeth.willers@vanderbilt.edu



Chest. 2006;130(6):1633-1635. doi:10.1378/chest.130.6.1633
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The current classification divides pulmonary arterial hypertension (PAH) into disease without an identifiable cause (idiopathic PAH [IPAH]) and that with a known cause, such as porto-pulmonary hypertension (PH), HIV-related PH, collagen vascular diseases, congenital systemic-to-pulmonary shunts, persistent PH of the newborn, and drug-related PH.1 Drugs considered to have a definite link to PAH are aminorex, fenfluramine, and dexfenfluramine.1 Stimulant use has been associated with vascular damage ranging from intracerebral hemorrhage2 to retinal vasculitis.3 Amphetamines are classified as “very likely” risk factors for PAH, while methamphetamine and cocaine are classified as “possible” risk factors.1 Given the continued use of stimulants as over-the-counter diet aids,4 the high prevalence of illicit drug use,4 and the increasing prevalence of attention deficit hyperactivity disorder, which is treated with methylphenidate,5 there is a need to firmly establish which drugs within this heterogeneous group of stimulants are true risks for PAH.

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