Khat chewing, cardiovascular diseases and other internal medical problems: The current situation and directions for future research

Abstract

The leaves of khat (Catha edulis Forsk.) are chewed as a social habit for the central stimulant action of their cathinone content. This review summarizes the prevalence of the habit worldwide, the actions, uses, constituents and adverse health effects of khat chewing. There is growing concern about the health hazards of chronic khat chewing and this review concentrates on the adverse effects on health in the peripheral systems of the body, including the cardiovascular system and gastrointestinal tract. Comparisons are made with amphetamine and ecstasy in particular on the detrimental effects on the cardiovascular system. The underlying mechanisms of action of khat and its main constituent, cathinone, on the cardiovascular system are discussed. Links have been proposed between khat chewing and the incidence of myocardial infarction, dilated cardiomyopathy, vascular disease such as hypertension, cerebrovascular ischaemia and thromboembolism, diabetes, sexual dysfunction, duodenal ulcer and hepatitis. The evidence, however, is often based on limited numbers of case reports and only few prospective controlled studies have been undertaken. There is therefore an urgent need for more thorough case-control studies to be performed. This review outlines the current knowledge on the adverse health effects of khat chewing on the cardiovascular system and other internal medical problems, it assesses the evidence and the limitations of the studies and identifies the questions that future studies should address.

La toxicité du khat impose-t-elle une modification de la réglementation de son usage en Europe?

“…Al Motarreb et coll. [9] rapportent des doses plus élevées en cathinone, entre 78 et 343 mg pour 10 grammes de feuilles fraîches.…”

“…Les propriétés physiologiques et effets de la consommation du khat ont fait l'objet de plusieurs publications [8,9,[26][27][28][29]. On décrit une augmentation de la pression artérielle, une tachycardie, une insomnie, une anorexie, une constipation, une irritabilité, des migraines, une altération des performances sexuelles chez l'homme [12,15].…”

“…Les effets aigus associés à l'usage du khat sont une augmentation modérée et transitoire de la pression artérielle et de la fréquence cardiaque [9,45]. La consommation régulière de khat est aussi associée à une élévation de la pression artérielle diastolique [46,47].…”

“…Chez le volontaire sain, l'augmentation de pression artérielle coïncide avec des concentrations plasmatiques de cathinone élevées [19]. Plusieurs observations expérimentales permettent de considérer la cathinone comme un agent sympathomimétique indirect [9].…”

A comprehensive computational analysis of cathinone and its metabolites using quantum mechanical approaches and docking studies

“…Along with cathinone, other less potent stimulant substances are also present in khat leaves, namely norephedrine and norpseudoephedrine (cathinone) [5]. Taking into account the structural and pharmacological properties of amphetamine and cathinone, it can be concluded that they should act similarly by inducing dopamine releases from central dopaminergic nerve terminals, thus increasing the activity of dopaminergic pathways [6,7].…”