Frequent Cocaine Use Linked to Heart Attack

May 08, 2002

Public Affairs

Belmont, MA - Frequent cocaine use triggers a dangerous series of events linked to risk of heart attack and stroke, report McLean Hospital researchers in the May 2002 issue of the American Journal of Cardiology.

Arthur Siegel, MD, chief of Internal Medicine at McLean, and colleagues monitored the hemostatic balance between blood-thickening and blood-thinning factors among individuals in two groups: 10 frequent users who take cocaine six to 20 times a week and 10 "recreational" users who take the drug between two and six times a month. Normally, blood-thickening factors promoted by inflammation guard against blood loss and initiate tissue repair after damage from injury, while blood-thinning factors limit potentially dangerous clotting effects. Frequent exposure to cocaine disrupts this balance by promoting inflammation and clotting effects, which could set the stage for heart attack and stroke.

"In previous studies, we demonstrated that each use of cocaine carries with it a transient or time-limited increase in cardiovascular risk," explained Siegel. "This study takes that research to the next step, showing that frequent users submit themselves to a cumulative risk from a systemic inflammatory response.

The researchers monitored the thickening and thinning balance in the study participants, specifically tracking: C-reactive protein (CRP), associated with inflammation and linked to arteriosclerosis; von Willebrand Factor (vWF) and fibrinogen, both indicators of clotting; and blood thinning or fibrinolytic activity. CRP, vWF and fibrinogen all were higher than normal in frequent users without a compensatory increase in thinning effects.

"This study shows an exposure-related increase in the risk of inflammation and clotting changes," said Siegel. "Using cocaine once is like playing Russian Roulette, but continued use compounds the risk, so it is like adding a second bullet to the chamber of the gun."

In addition to evaluating an individualís cardiovascular risk including cocaine usage, these markers may assist in counseling individuals, help clinicians assess the severity of cocaine use and lead to interventions designed to lower risk while addressing addiction.

"C- reactive protein could be used to test for cocaine use the same way glycohemoglobin levels are used to test for diabetes mellitus," explained Siegel. "CRP could be an objective measure for patients and their doctors to manage illness by assessing risk and monitoring progress based on interventions."

Investigators across Partners Healthcare at Brigham and Women's Hospital, Massachusetts General Hospital, and elsewhere in Harvard Medical School at Beth Israel-Deaconess Medical Center were among those collaborating on this research.

McLean Hospital maintains the largest research program of any private, U.S. psychiatric hospital. It is the largest psychiatric teaching facility of Harvard Medical School, an affiliate of Massachusetts General Hospital and a member of Partners HealthCare System.

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