Does the use of cocaine put young adults more at risk of ischemic stroke?
Cocaine is a highly addictive stimulator of the central nervous system that exerts its recreational effect by increasing the levels of the pleasure and movement-associated neurotransmitter; dopamine, in the brain. In the USA, cocaine is one of the most frequently abused drugs with an estimated 3-fold increase in its use amongst young adults reporting stroke between 1993 and 2005. Cocaine has multiple effects on the body that could lead to it predisposing an individual to ischemic stroke (IS). These include induction of hypertension or vasoconstriction related to the inhibitory effect it conveys on sympathetic nerve catecholamine uptake, depression of myocardial contractility or induction of ventricular arrhythmia related to its ability to block sodium and potassium ion channels at high doses and its generic ability to induce a prothrombotic state.
Recently, Cheng et al. conducted a population-based case-control study investigating the association between cocaine usage and IS risk in young adults. More specifically, the effects of timing of drug use and route of cocaine administration within this context were explored. Overall, analyses included information taken from 1090 first-ever IS participants and 1152 stroke-free control participants within the 15-49 year age range. Strikingly, participants reporting acute use of cocaine before the study reference time of 24 hours had a 5.7-fold increased risk of IS in comparison to participants that had never used cocaine. In addition, the majority of the 26 IS participants that fell into the acute cocaine use category stated that they took the drug within the 6 hour time period prior to stroke onset and administered it into their system by smoking. No association was found between risk of stroke and cocaine use months or years prior to the investigated study period. Taken together, these findings suggest that cocaine is a strong contributory factor for IS in young adults indicating that toxicology screening could be a valuable tool for future stroke evaluation of these individuals.
Original Research Article: Cheng YC, Ryan KA, Qadwai SA, Shah J, Sparks MJ, Wozniak MA, Stern BJ, Phipps MS, Cronin CA, Magder LS, Cole JW, Kittner SJ. Stroke. 2016 Apr;47(4):918-22. doi: 10.1161/STROKEAHA.115.011417. Epub 2016 Mar 10.PMID: 26965853
Image source: By Nightlife Of Revelry – Cocaine, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=47087565
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