This study examines trends and disparities in substance use disorders (SUD) and cardiovascular disease(CVD)-related mortality, focusing on alcohol, opioids, and cocaine use and major CVD outcomes.

SUDs are major contributors to CVD mortality, yet population-level data on specific substances and CVD drivers remain limited.

Death certificates from the CDC WONDER database (2010-2023) were analyzed to assess SUD- and CVD-mortality among adults aged between 25-64 years old. CVD included ischemic heart disease (IHD), hypertensive heart disease (HHD), heart failure (HF), arrhythmias, cardiomyopathy, cardiac arrest and stroke. Age-adjusted mortality rates (AAMRs) per million (95% Cls), annual percentage change (APC), and its average (AAPC) were calculated.

Between 2010 and 2023, 339,286 SUD and CVD-related deaths occurred, 69.7% from alcohol and 23.5% from opioids. The highest total AAMR was seen in alcohol- and CVD-related deaths (87.0), followed by opioids (32.7), and cocaine (27.8). However, the AAPC in opioid-related CVD mortality was almost double that of alcohol (8.1 vs 3.9). Overall, SUD- and CVD-related mortality increased from 2010-2023 (AAPC: 5.8). Alcohol and opioid related CVD deaths rose steadily from 2010-2018, (APC: 4.2 and 6.4), followed by a steeper increase from 2018-2021 (APC: 16.9 and 17.5), after which rates were relatively stable. For cocaine, mortality was relatively stable before 2013, then rose steadily thereafter (APC: 8.8). Overall, men had nearly triple the AAMR of women. NH American Indians had the highest rates, about double those of NH Blacks and Whites.

SUD and CVD-related mortality continue to rise, driven by steep increases in cocaine and opioids, while alcohol remains the most persistent burden. Although alcohol and opioid related deaths have stabilized since 2021, cocaine related mortality has shown no improvement since 2013. Persistent disparities among men and NH American Indians highlight the need for targeted interventions.