Cocaine Increases Stroke Risk

SAN DIEGO, California — Cocaine greatly increases ischemic stroke risk in young adults within 24 hours of use, a new study has found. Results showed that stroke risk associated with acute cocaine use was much higher than that seen with other established risk factors, including diabetes, high blood pressure, and smoking.

The study was presented here at the American Stroke Association (ASA) International Stroke Conference (ISC) 2014 by Yu-Ching Cheng, PhD, University of Maryland School of Medicine, Baltimore.

"Cocaine is not only addictive, it can also lead to disability or death from stroke," Dr. Cheng said at a press conference here. "With few exceptions, we believe every young stroke patient should be screened for drug abuse at the time of hospital admission."

Moderator of the ASA press conference on the study, Larry Goldstein, MD, Duke University Medical Center, Durham, North Carolina, said, "The take-home message for young people is 'Don't do cocaine.' You could end up not being able to talk or use one side of your body from doing this."

Noting that between a quarter and a third of the young people in this study said they had used cocaine at some time, Dr. Goldstein said: "That is scary." He added that crack cocaine is more dangerous than snorting cocaine because it is injected so it reaches higher concentrations in the blood.

Acute Use

For the study, Dr. Cheng and her colleagues compared 1101 patients aged 15 to 49 years in the Baltimore–Washington, DC, area who had strokes in 1991–2008 with 1154 controls of similar ages in the general population.

Results showed that having a history of cocaine use was not associated with ischemic stroke, but acute use of cocaine in the last 24 hours was strongly associated with increased risk for stroke; use of cocaine was linked to a 7-fold increase in stroke risk within the next 24 hours, after adjusting for age, sex, and ethnicity. The effect remained after adjusting for smoking.

Table. Risk Factors Associated With Stroke in Young Adults

Factor	Stroke Patients (%)	Controls (%)	P Value
History of diabetes	16.9	4.6	<.001
History of hypertension	41.7	18.1	<.001
Current smokers	45.1	29.4	<.001
Cocaine use ever	28.1	25.7	.95
Cocaine use in past month	3.7	2.7	.67
Cocaine use in past 24 h	2.4	0.4	.001

The strength of the association between acute cocaine use stroke was similar in whites (age-adjusted odds ratio [OR], 6.1) and African Americans (age-adjusted OR, 6.7). But the risk for stroke after using cocaine appeared to be higher in women (OR, 12.8) than in men (OR, 2.5) after adjustment for the effect of age, ethnicity, and current smoking status, although this was not statistically significant.

Dr. Goldstein noted that cocaine causes arrhythmias and myocardial infarction, which can lead to stroke. It also has a direct vasoconstrictor effect on the cerebral vasculature, and these effects are potentiated by alcohol.

Dr. Cheng has disclosed no relevant financial relationships.

International Stroke Conference (ISC) 2014. Abstract WMP57. Presented February 12, 2014.

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