Regular Cocaine Use Associated With Adverse Cardiovascular and Respiratory Outcomes

Cocaine use has been associated with adverse cardiovascular and pulmonary outcomes, but previous research has been limited by cross-sectional analysis and failure to adjust for important confounders, especially tobacco use. This study used data on 426,112 patients treated at a health system in Ohio from 1999 to 2018 to investigate the association between “regular” cocaine use* and adverse cardiovascular and pulmonary outcomes. Researchers adjusted their analyses for age, sex, race, median income of zip code of residence, body mass index, and tobacco use.

  • A total of 8244 individuals met criteria for regular cocaine use and were compared with 8244 control individuals with similar demographic variables.
  • Cocaine use was associated with an increased risk of myocardial infarction (adjusted odds ratio [aOR], 2.9), cerebrovascular accidents (aOR, 2.5), and heart arrhythmia (aOR, 1.3), but not subarachnoid hemorrhage (aOR, 1.1).
  • Cocaine use was also associated with respiratory outcomes, including an increased risk of pneumonia (aOR, 2.9), COPD (aOR, 2.5), and asthma (aOR, 2.3).
  • Cocaine use was associated with higher all-cause mortality (aOR, 3.9).

* Defined as having a diagnosis of cocaine use disorder, or ≥2 cocaine-positive urine drug tests.

Comments: This study strongly suggests a relationship between cocaine use and a number of adverse health outcomes, but could not account for frequency or route of use. Evidence for causation would be strengthened by studies demonstrating a dose-response relationship between cocaine use and adverse outcomes.

Darius A. Rastegar, MD

Reference: Winhusen T, Theobald J, Kaelber DC, Lewis D. The association between regular cocaine use, with and without tobacco co-use, and adverse cardiovascular and respiratory outcomes. Drug Alcohol Depend. 2020;214:108136.

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