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Cocaine Use and Pulmonary Hypertension
Bashar N Alzghoul1, Amjad Abualsuod2, Bilal Alqam3
1Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida; Department of Medicine, University of Florida, Gainesville, Florida.
The American Journal of Cardiology
|November 24, 2019
Summary
Cocaine use is linked to higher pulmonary artery pressure and an increased risk of pulmonary hypertension (PH), even without other known causes. This suggests a potential acute-on-chronic effect from cocaine, impacting cardiovascular health.
Area of Science:
- Cardiology
- Pulmonology
- Toxicology
Background:
- Limited and inconsistent evidence links cocaine use to pulmonary hypertension (PH) risk.
- Cocaine's cardiovascular effects, particularly on pulmonary vasculature, require further investigation.
- Understanding cocaine-induced PH is crucial for patient management and public health.
Purpose of the Study:
- To investigate the association between cocaine use and elevated systolic pulmonary artery pressure (sPAP) and PH probability.
- To determine if cocaine use, independent of other causes, increases the risk of PH.
- To explore the dose-response relationship between cocaine use and PH likelihood.
Main Methods:
- Retrospective comparison of patients with documented cocaine use versus a matched control group without cocaine history.
- Noninvasive estimation of sPAP using echocardiography in all participants.
- Application of contemporary guidelines to assess PH probability based on echocardiographic parameters.
Main Results:
- Cocaine users exhibited significantly higher sPAP (30.1 ± 13.1 mm Hg) compared to controls (22.0 ± 9.8 mm Hg).
- The prevalence of PH was significantly greater in cocaine users (25%) than in controls (10%).
- Multivariable analysis revealed cocaine use conferred a fivefold increased odds of echocardiographic PH, with a trend towards increased PH likelihood correlating with drug screen results.
Conclusions:
- Cocaine use is associated with elevated sPAP and an increased likelihood of PH.
- Findings suggest a probable acute-on-chronic effect of cocaine use on pulmonary artery pressure.
- Further research is warranted to elucidate the precise mechanisms and long-term consequences of cocaine-induced PH.