Clinical Research StudyCocaine and the Long-Term Risk of Cardiovascular Disease in Women
Introduction
Cardiovascular disease is a leading cause of death in women,1 yet little attention is paid to illicit substances that can adversely affect the cardiovascular system.2, 3, 4 Mortality due to substance use is increasing in women, including deaths from stimulants such as cocaine.5 Cocaine is derived from Erythroxylum coca (coca bush) and is one of the most frequently used illicit substances in North America. Reports suggest that about 1% of adolescent girls and young women use cocaine.6, 7, 8 Cocaine is extremely addictive and may lead to cocaine use disorders that have a significant impact on women.6,9 Cocaine contributes considerably to substance-related mortality in young women,5 but the influence of cocaine use disorders on risk of cardiovascular disease in women of reproductive age has not been studied.
The acute effects of cocaine on the cardiovascular system are well known. Short-term use of cocaine is associated with greater atherosclerotic plaque volume, increased incidence of myocardial infarction, and sudden cardiovascular death.4,9 However, the medium and long-term cardiovascular risks of cocaine use are less understood, particularly among women. In an analysis of approximately 2000 patients, women who used cocaine on a regular basis were twice as likely as non-users to suffer from hypertension up to 5 years later, while there was no association in men.10 Women who use cocaine during pregnancy have greater odds of myocardial infarction and cardiac arrest during pregnancy and delivery.11 A study of 321 women suggested that cocaine use during pregnancy was associated with a greater risk of heart failure 10 years later.12 Cocaine use during pregnancy is associated with a two- to threefold greater risk of adverse birth outcomes, including preterm birth, low birth weight, and placental disorders.13,14 These pregnancy complications are also associated with an increased risk of cardiovascular disease.15 Characterizing the link between cocaine use disorders and future cardiovascular events is needed to tailor prevention and surveillance efforts in women. We therefore examined the relationship between cocaine use disorders and risk of cardiovascular hospitalization over the course of 3 decades in a large population of parous women.
Section snippets
Study Design and Population
We designed a longitudinal cohort study of 1,296,463 parous women in Quebec, Canada between 1989 and 2019. We extracted the women from the Maintenance and Use of Data for the Study of Hospital Clientele registry.16 The dataset contains discharge abstracts for all hospitalizations in Quebec since April 1989, including 99% of deliveries. The cohort is representative of parous women in the province and is extensively validated to ensure accuracy of data.16
Using health insurance numbers, we
Results
In this longitudinal cohort of 1,296,463 parous women, 2954 women (0.2%) had a cocaine use disorder prior to or during pregnancy. A large proportion of the women in the cohort were between the ages of 25 and 34 years (67.0%) and nulliparous (42.8%). Approximately 18% lived in rural areas and 3.6% had a history of mental illness. Only 2.8% had a tobacco use disorder and 0.8% other substance use disorders.
Among women with cocaine use disorders, 42.6% used cocaine during pregnancy (Table 1). Women
Discussion
Cocaine use is an understudied public health problem that is prevalent in North America, but has considerable potential to contribute to cardiovascular morbidity. In this cohort of 1.3 million women of reproductive age followed for up to 31 years, women with cocaine use disorders had an elevated risk of a range of adverse cardiovascular outcomes, including inflammatory heart disease, cardiac arrest, valve disease, and arterial embolism. Women with cocaine use disorders were at greatest risk of
Conclusions
Cocaine use is common among young women, yet its long-term cardiovascular effects are poorly understood. This large cohort study suggests that women with cocaine use disorders early in life are at risk of cardiovascular disease several decades later. The findings highlight the need to better document the implications of cocaine for health over the life course. Interventions and strategies targeting young women at high risk of cocaine use, including women who misuse other substances or are in
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Long-Term Outcomes of Women With Peripartum Cardiomyopathy Having Subsequent Pregnancies
2023, Journal of the American College of CardiologyCocaine and Ischemic or Hemorrhagic Stroke: A Systematic Review and Meta-Analysis of Clinical Evidence
2023, Journal of Clinical Medicine
Funding: This study was supported by the Canadian Institutes of Health Research (PJT-156062) and Heart & Stroke Foundation of Canada (G-18-0021776). The authors acknowledge salary support from the Fonds de recherche du Québec-Santé (Ukah 276184, Potter 267436, Auger 296785). The funding sponsors were not involved in study design; in the collection, analysis, and interpretation of data; in writing the report; and in the decision to submit the article for publication.
Conflicts of Interest: None.
Authorship: UVU, BJP, GP, NL, and NA conceived and designed the study. AA performed data analysis with input from UVU and NA. All authors contributed to data interpretation. UVU, AA, and NA drafted the manuscript, and BJP, GP, and NL revised it critically for important intellectual content.