Recent cocaine use amplifies stroke risk in the young

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Young adults who reported cocaine use within 24 hours had a six- to seven-fold increase in risk for ischemic stroke, according to research presented Feb. 12 at the meeting of the International Stroke Conference of the American Heart Association in San Diego. This increase is especially significant among women, even though women use cocaine less frequently.

Yu-Ching Cheng, PhD, of the University of Maryland School of Medicine in Baltimore and colleagues recruited more than 2,255 participants between the ages of 15 and 49 from the Baltimore-Washington, D.C. area. They compared 1,101 men and women who had a first-time ischemic stroke between 1992 and 2008 with 1,154 controls with no stroke history. They interviewed all participants to ascertain risk factors for stroke and a history of illegal drug use.

“Although uncommon, stroke in young adults can be devastating due to loss of productive years and decreased quality of life, and identifying preventable and modifiable risk factors for stroke in the young is particularly important,” Cheng told Cardiovascular Business.

Overall, 28 percent of the stroke group and 26 percent of controls reported cocaine use, with men twice as likely as women to say they have used the drug (36 percent vs. 18 percent) and African Americans slightly more likely than whites (30 percent vs. 26 percent).

While they did not find an association between a history of cocaine use and ischemic stroke in the overall sample or in the subgroups of gender and ethnicity, they found a strong association between reporting the use of cocaine within the 24 hours before a stroke and an increased risk of stroke (2.4 percent of cases vs. 0.4 percent of controls). The effect was similar between whites and African Americans, but much stronger in women (odds ratio 12.8 vs. 2.5 for men) after adjusting for age, ethnicity and current smoking status.

Cheng said when young adults present with a stroke but few risk factors, clinicians should perform toxicology testing to screen for substance abuse at the time of admission.

“Identifying substance-abusing patients early in their time course helps define potential stroke etiologies and allows for treatment optimization, including potential withdrawal syndromes that can hamper both treatment and recovery,” he explained. He also said that intervening early can minimize the risk of recurrent strokes due to continued substance abuse.