Cocaine: the perfect heart attack drug?

By George Gifford

A recent paper, presented at the American Heart Association's Scientific Sessions 2012, suggests that using cocaine as little as once a month can lead to stiffening and narrowing of blood vessels (atherosclerosis) and thicker heart muscle walls (hypertrophic cardiomyopathy). The results of study have broken new ground: firstly because the cocaine users in the study did not use massive amounts of the drug; secondly because the cocaine users in this study were not dead, most other studies suggesting that cocaine may cause stiffening of blood vessels being post mortem. 

Being about drugs and death, this study was quickly picked up by newspapers, using the soundbite, ‘Cocaine- the perfect heart attack drug’. Now, the negative effects of cocaine on the cardiovascular system have actually been explored for some time and are not surprising given cocaine’s well known acute effects of blood pressure and heart rate, and the substantial amount of case reports of cocaine induced heart attacks. Very relevantly, there have also been some larger studies (epidemiological studies) linking regular cocaine use to an increased likelihood of having a heart attack. The point here is that there is already a body of evidence linking cocaine use to heart attacks and associated damage to the cardiovascular system.

This is important because the study in question only involved 20 cocaine using participants, meaning without past research, it would make a weak case for the relationship between cocaine use and the increased likelihood of having a heart attack. With this in mind, you can take the Daily Mail’s headline ‘Cocaine is ‘the perfect heart attack drug’- even if you use it a few times a year’, with some scepticism. All of the participants used the drug at least once a month and there were only 20 of them meaning, as it stands, it really applies to regular (at least monthly) users. 

This is not to say that cocaine does not have a specific underlying action that causes damaging changes to the heart and blood vessels as the study suggests, quite the opposite. This study provides an answer to the question of why cocaine may cause heart attacks in those otherwise not at risk. The problem is that how the study has been reported (and drug science is often reported) sensationalises the drug harms without really providing any useful information.

For example, it would be common sense to mention that cocaine use would be more dangerous if you were doing something that also causes atherosclerosis, namely smoking (if you need convincing, here is a study of 91 case reports of cocaine induced heart attacks- 87% of which were cigarette smokers). Additionally, some people have a genetic predisposition to thickening of heart muscle, which is actually one of the most common genetic heart conditions out there, and can often go undetected (until people have sudden heart attacks). The main advice here is that anyone with a family history of sudden heart attacks (especially in younger relatives) may be at particular danger from further thickening of the muscle in the heart. 

It would have been helpful if papers mentioned that taking cocaine if you have high blood pressure or pre-existing heart problems could be particularly harmful or at the very least linked readers to some kind of cocaine harm reduction information. In absence of this, the impression we get is that the writers of such articles take it upon themselves to portray drugs in as harmful a light as possible, to convince people to never use the drug ever. Whilst this may deter people who have never used the drug, drug users can be those who are fully aware of the risks, but don’t see them as that personally relevant. 

With this in mind, here are the take home points of what the study suggests, and how they could relate to you: 

•    Thickening of the heart’s walls and stiffening of blood vessels is likely with regular (even just monthly) use of cocaine.
•    If you are already doing something that can cause athesclerosis (e.g. smoking), regular cocaine use could add to this, making it riskier.
•    If there is a history of sudden cardiac deaths in the family, cocaine may be particularly harmful to you.