From Our 2014 Archives
Cocaine Use Spurs Steep, Short-Term Rise in Stroke Risk: Study
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The risk for stroke associated with cocaine use is much higher than with other stroke risk factors, such as diabetes, high blood pressure and smoking, said the researchers from the University of Maryland School of Medicine.
"Cocaine is not only addictive, but it can also lead to disability or death from stroke," said lead researcher Yu-Ching Cheng, an assistant professor of medicine at the University of Maryland School of Medicine.
Cheng said physiological reasons might account for the increased risk of stroke.
"Cocaine use can result in the constriction of blood vessels; increased heart rate, body temperature and blood pressure; and decreased oxygen supply to the brain," said Cheng, who also is a research scientist at the Baltimore Veterans Affairs Medical Center. "These physiological effects may boost the risk of stroke."
It is estimated that about 13,000 Americans aged 15 to 44 suffer a stroke each year, Cheng said.
"Based on the data in our study, we estimated that about 300 young stroke cases are associated with acute cocaine use each year, but the estimate may vary depending on the prevalence of cocaine use in different sub-populations," she said.
With few exceptions, every young stroke patient should be screened for drug abuse when admitted to the hospital, Cheng said. Only a third of these patients currently get tested for drug use, according to the study.
The findings were scheduled to be presented Wednesday at the American Stroke Association International Stroke Conference in San Diego. Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.
Dr. Scott Krakower, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y., said, "Cocaine is a very potent substance, and is often sought out by young adults for its thrills and extreme highs."
"They do not realize the paradoxical effects it may have, including worsening mood, anxiety and behavior," Krakower said. "In addition, it may lead to serious consequences at any time, like acute stroke."
For the study, Cheng's team compared more than 1,000 people aged 15 to 49 who had strokes between 1991 and 2008 with a similar number of people in the general population.
More than 25 percent of the people in both groups said they had a history of using cocaine. Men were twice as likely to have used the drug as women, the researchers said.
Although a history of cocaine use was not linked with the risk of having a stroke, using cocaine in the previous 24 hours was associated with an increased risk of having a stroke, they found.
The risk of having a stroke was six to seven times higher within 24 hours of using cocaine. The risk was similar for both whites and blacks, the researchers said.
Although the study found an association between using cocaine and an increased risk of stroke in younger adults, it did not prove a cause-and-effect link.
One expert, however, noted the strength of the association.
"Cocaine comes up over and over as being implicated in stroke in people of all ages," said Dr. Richard Libman, vice chairman of neurology at Long Island Jewish Medical Center in New Hyde Park, N.Y.
Cocaine wreaks havoc on the heart, Libman said. "It can cause all kinds of abnormal rhythms that can cause blood clots to form and cause a stroke," he said.
"In addition, cocaine may also have a direct effect on blood vessels in the brain, causing them to go into spasm and narrow, resulting in a decrease of blood to the brain," Libman said. "Cocaine may even cause inflammation in the blood vessels of the brain, and cause stroke."
SOURCES: Yu-Ching Cheng, Ph.D., research scientist, Baltimore Veterans Affairs Medical Center, and assistant professor, medicine, University of Maryland School of Medicine, Baltimore; Scott Krakower, D.O., assistant unit chief, psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y.; Richard Libman, M.D., vice chairman, neurology, Long Island Jewish Medical Center, New Hyde Park, N.Y.; Feb. 12, 2014, presentation, American Stroke Association International Stroke Conference, San Diego