1999


From: American Heart Association

More bad news for cocaine users: Drug can triple risk of aneurysm

ATLANTA, Nov. 9 -- The bad news continues to mount for cocaine users. Cocaine has already been linked to an increased risk of heart attack and stroke. New research being presented today at the American Heart Association Scientific Sessions finds, for the first time, that cocaine use can lead to the development of aneurysms in heart arteries.

An aneurysm is a ballooning-out of the wall of an artery. An aneurysm in a heart artery may lead to a heart attack. An aneurysm in an artery of the brain could burst and trigger a stroke. Some aneurysms do not cause symptoms, while others may cause chest pain and other coronary artery disease symptoms.

"After observing severe coronary artery aneurysms in a large number of young cocaine users, we wanted to determine if the drug was the cause of these aneurysms," says Aaron Satran, M.D, chief medical resident at Hennepin County Medical Center. "Our findings strongly indicate that cocaine use is associated with an increased risk of aneurysms, and that the more cocaine consumed, the higher an individual's risk of developing an aneurysm."

Researchers at Hennepin County Medical Center in Minneapolis looked at 112 individuals who admitted using cocaine. All had a history of chest pains and other cardiovascular health problems, and all underwent an imaging test called angiography, in which dye is injected into the arteries and an x-ray is then taken. The average age of those in the study was 44, and 80 percent were male.

"We found that 30 percent of these patientsm--three out of 10--had aneurysms in a heart artery. This is an extremely high percentage compared to the overall number of coronary artery aneurysms seen among patients referred for angiography," Satran says.

For example, a large-scale trial known as CASS (Coronary Artery Surgery Study) found that fewer than 5 percent of the 20,000 patients referred for angiography had an aneurysm in a heart artery. The percentage of patients in the Minneapolis study who had an aneurysm was six times higher.

"Coronary artery aneurysms are rare, even among patients with diagnosed heart disease," says Satran. "We've known for some time that cocaine use can trigger sudden heart attack and stroke, but until now, we didn't know that cocaine can also increase an individual's risk of developing aneurysms in the heart arteries."

The next step for researchers, Satran says, is to try to figure out what mechanisms are involved in the association between cocaine use and the development of aneurysms. Aneurysms in heart arteries have been associated with certain rare connective tissue diseases, including Kawasaki's disease, which usually shows up in children.

Cocaine use was confirmed in the study participants by voluntary admission or a urine test. "Most of the people involved in our study were very cooperative, and quite willing to talk about their drug use as well as other medical problems," says Satran.

In addition to their increased risk for developing an aneurysm, Satran says 73 percent of those involved in the study had high blood pressure, 71 percent had high cholesterol levels and 95 percent were cigarette smokers.

"The study provides evidence of further risk of cardiac damage from cocaine use, and suggests that cocaine use causes blood vessel damage and accelerates atherosclerosis," says Satran. "Furthermore, we do not believe this damage is reversible."

Co-authors were Bradley A. Bart, M.D.; M. Bilal Murad, M.D., and Timothy D. Henry, M.D.












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