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 Based on a comparison of younger victims of a first stroke, using
cocaine in the 24 hours before the event raised the risk
substantially – up to eight-fold when the drug was smoked in “crack”
form, researchers found.
“Among other factors, we know that cocaine causes rapid increase in
blood pressure and also can cause cardiac problems that can lead to
stroke,” said senior author Dr. Steven J. Kittner of the University
of Maryland School of Medicine and the Veterans Affairs Maryland
Health Care System in Baltimore.
The researchers analyzed data from a study that took place between
1992 and 2008, identifying more than 1,000 cases of ischemic stroke
in people ages 15 to 49 years from hospitals in the Baltimore/
Washington D.C. area. Ischemic stroke is caused by the blockage of a
blood vessel in or leading to the brain, often by a blood clot, and
is the most common kind of stroke.
The researchers matched these stroke cases to 1,152 similar people
who had not suffered a stroke.
Participants were asked to recall whether they had ever used drugs,
pills or medications for nonmedical or recreational reasons or to
get high.
The stroke victims were more likely than the comparison group to be
tobacco smokers and to have a history of diabetes and high blood
pressure.
History of cocaine use was similar in both groups, with 28 percent
of stroke victims and 26 percent of the comparison group saying they
had used the drug at some time in their lives. A history of ever use
was not linked to increased stroke risk, the researchers report in
the journal Stroke.
People who said they had used cocaine over the previous day were
more than six times as likely to have suffered a stroke as people
who reported never having used cocaine. That result did not change
much even after researchers adjusted for tobacco smoking and alcohol
use.
Only 26 people reported cocaine use within 24 hours of their stroke,
and 14 said they had used within six hours of the event, researchers
note.
Roughly 10 to 20 young people per 100,000 suffer an ischemic stroke,
and risk is much higher for African Americans than for Caucasian
people, Kittner said.
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No observational study like this one can “prove” causation, but a
strong case can be made that using cocaine does cause stroke, based
on the totality of evidence, he told Reuters Health by email.
But this study is very important for clinical practice, said Dr.
Antonio Siniscalci of Annunziata Hospital in Cosenza, Italy, who was
not part of the new study.
In particular, smoking crack cocaine seems to be associated with
stroke, whereas cocaine hydrochloride causes mainly bleeding of the
brain, Siniscalci told Reuters Health by email.
“It is reasonable to screen young patients, particularly men, for
drug use when they present with cryptogenic stroke,” or stroke of
unknown origin, he said.
“Unfortunately, this is not likely to be a deterrent for addicted
users or even for most considering first use,” Kittner said.
“However, it is possible that a small percent of potential users
could be deterred.”
SOURCE: http://bit.ly/1pqhFS9 Stroke, online March 10, 2016.
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