Increased Prevalence of Aortic Fatty Streaks in Cholesterol-Fed Rabbits Administered Intravenous Cocaine: The Role of Vascular Endothelium*¹

Abstract

Several recent postmortem studies suggest an increased prevalence of atherosclerosis in young habitual cocaine abusers. However, little is known about the effects of cocaine abuse on the vascular endothelium and its relationship to atherosclerosis. Therefore, the consequence of chronic administration of intravenous cocaine on the induction of aortic sudanophilia was examined. Male New Zealand White rabbits were fed a 0.5% cholesterol diet for 10 wk. During this period, animals were randomized to receive either cocaine-hydrochloride (0.25 mg/kg) intravenously (n = 17) twice daily; or an equivalent volume of 0.9% physiologic saline, control group (n = 16). Mean values for total circulating leukocytes and platelets and total plasma cholesterol and triglycerides were similar in both groups throughout the protocol. At the completion of the study, aortic sudanophilia was measured and expressed as a percentage of regional involvement (R1 = proximal 4 cm, R2 = middle 6 cm, and R3 = distal 10 cm). Statistical significance among groups was achieved in the proximal thoracic aorta (p = 0.057). No significant differences in sudanophilia were noted in the middle and distal segments. When animals were placed in subgroups according to percent total plaque involvement, there was a significant increased distribution of rabbits with a greater extent of sudanophilia in the cocaine-treated group as compared with control (p = 0.01, chi-square analysis). Immunocytochemical studies using the macrophage-specific and muscle actin-specific monoclonal antibodies demonstrated that sudanophilic areas in both groups were predominantly composed of macrophage-derived foam cells. Evaluation of plaque morphology showed an increase in intimal plaque thickness and in the number of macrophages and smooth muscle cells in cocaine-treated animals; however, group differences were not statistically significant. Because no significant differences were found in the cellular composition of atherosclerotic plaques between groups, further studies were performed to assess the effects of cocaine on the permeability function of cultured endothelial cell monolayers as a possible mechanism of increased sudanophilia. Cocaine (100 microM)-treated endothelial cell monolayers demonstrated an increased permeability to horseradish peroxidase during all time intervals studied (0-6 hr). Permeability differences were statistically significant at 30 min and 1 hr (p = 0.003 and 0.02, respectively). Collectively, these observations suggest that administration of cocaine to cholesterol-fed rabbits increases the prevalence of aortic sudanophilia via at least one possible mechanism involving enhanced vascular permeability.

Cocaine Use and Hypertensive Renal Changes in HIV-Infected Individuals

“…Many experimental and autopsy studies (25)(26)(27)(28) confirm that cocaine also has pronounced atherogenic activity. One in vitro study (29) suggested that cocaine increases the predisposition to atherosclerosis by enhancing the permeability of the vascular endothelium and thereby the diffusion of atherogenic lipoproteins into the intima. Furthermore, cocaine has been associated with accelerated and malignant hypertension as well as with hastening the progression of hypertensive nephrosclerosis to ESRD (30,31), although confirmation by renal biopsy was not attained.…”

Side Effects of Cocaine Abuse: Multiorgan Toxicity and Pathological Consequences

“…The pathophysiology of cocaine-related renal injury is multifactorial and involves renal hemodynamic changes, alterations in glomerular matrix synthesis, degradation and OS, and possible induction of renal atherogenesis [148,[302][303][304] . Fig.…”

“…Cocaine has been linked to accelerated atherogenesis in both animal experiments and human studies and autopsy findings [148,149,303,311]. Cocaine increased thromboxane production and platelet aggregation in in vitro platelet cultures [312] and platelet activity, measured by platelet p-selectin expression, in human and canine models [142,313].…”

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

“…Many of the initial studies reported a temporal association between cocaine use and MI, 19,31,32 whereas multiple experimental and observational studies subsequently elucidated the mechanisms for cocaineassociated MI. 13,16,23,[25][26][27][33][34][35] In the COCaine Associated CHest PAin (COCHPA) study, cocaine-associated MI occurred in 6% of patients who presented to the ED with chest pain after cocaine use. 19 In that prospective multicenter study, the diagnosis of MI was made by creatine kinase-MB isoenzyme measurements among 246 patients presenting to the ED with chest pain after cocaine ingestion.…”