Regular Cocaine Use Is Associated with Increased Systolic Blood Pressure, Aortic Stiffness and Left Ventricular Mass in Young Otherwise Healthy Individuals

Abstract

BackgroundThe cardiovascular impact of cocaine use in otherwise healthy individuals who consider themselves ‘social’ users is not well established.Methods/ResultsTwenty regular cocaine users and 20 control subjects were recruited by word-of-mouth. Cardiovascular magnetic resonance was performed to assess cardiac and vascular structure and function. Cocaine users had higher systolic blood pressure compared to non-users (134±11 vs 126±11 mmHg, p = 0.036), a finding independent of age, body surface area, smoking and alcohol consumption. Cocaine use was associated with increased arterial stiffness - reflected by reduced aortic compliance (1.3±0.2 vs 1.7±0.5 cm2×10−2.mmHg−1, p = 0.004), decreased distensibility (3.8±0.9 vs 5.1±1.4 mmHg−1.10−3, p = 0.001), increased stiffness index (2.6±0.6 vs 2.1±0.6, p = 0.005), and higher pulse wave velocity (5.1±0.6 vs 4.4±0.6 m.s−1, p = 0.001). This change in aortic stiffness was independent of vessel wall thickness. Left ventricular mass was 18% higher in cocaine users (124±25 vs 105±16 g, p = 0.01), a finding that was independent of body surface area, and left atrial diameter was larger in the user group than controls (3.8±0.6 vs 3.5±0.3 cm, p = 0.04). The increased left ventricular mass, systolic blood pressure and vascular stiffness measures were all associated with duration and/or frequency of cocaine use. No late gadolinium enhancement or segmental wall motion abnormalities were seen in any of the subjects.ConclusionsCompared with the non-user control cohort, cocaine users had increased aortic stiffness and systolic blood pressure, associated with greater left ventricular mass. These measures are all well known risk factors for premature cardiovascular events, highlighting the dangers of cocaine use, even in a ‘social’ setting, and have important public health implications.

Cardiovascular consequences of cocaine use

“…For example, in a recent study utilizing coronary computed tomography angiography, Ebersberger et al [47] demonstrated more pronounced coronary atherosclerosis in cocaine users experiencing acute chest pain, even in the absence of an acute coronary event, compared to non-cocaine users. Others have reported signs of cardiovascular damage, including increased systolic blood pressure, aortic stiffness, increased left ventricular mass, and bradycardia, in otherwise healthy young individuals who chronically use cocaine [32][33][34]. This chronic cardiovascular damage results in an increased risk of the acute coronary syndromes described above as well as risks for diseases associated with ongoing myocardial cell death and atherosclerotic processes, such as cardiomyopathy [48][49][50][51] and endocarditis.…”

“…Over time, with ongoing cocaine use hypertension, aortic stiffness, left ventricular mass, and other measures of adverse cardiovascular dynamics progressively worsen in otherwise healthy young individuals [32][33][34]. In combination, these effects can result in myocardial ischemia, infarction, and other long-term deleterious effects.…”

Vascular disease in cocaine addiction

“…These effects, as well as others (e.g., myocardial edema), may show a cocaine dose-related response [73]. Other reports document aortic damage including dilatation [78], reduced strain, compliance and distensibility [74,80], and increased stiffness index and pulse wave velocity [74]. Furthermore, asymptomatic or subclinical cardiovascular disease is shown in coronary calcification, plaque and stenosis and found to be independently associated with cocaine use [81].…”

HIV, Cocaine Use, and Hepatitis C Virus

“…One small Australian study found cocaine use to be associated with increased aortic PWV. 36 That study measured PWV with cardiac and aortic magnetic resonance imaging and we used applanation tonometry for PWV measurement, limiting the ability to make direct comparisons.…”