Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
Int J Cardiol. 2012 Jul 12;158(2):211-6. doi: 10.1016/j.ijcard.2011.01.032. Epub 2011 Feb 3.
Chronic cocaine use may lead to premature atherosclerosis, however, the prevalence of and risk factors for coronary artery disease in asymptomatic cocaine users have not been reported.
Between August 2007 and June 2010, 385 African American chronic cocaine users aged 25 to 54 years were consecutively enrolled in a study to investigate the prevalence of CT angiographically-defined significant (≥ 50%) coronary stenosis and related risk factors. Sociodemographic, drug-use behavior, medical history and medication data were obtained by interview and confirmed by medical chart review. Clinical examinations were performed as well as extensive laboratory tests including those for fasting lipid profiles, HIV, high sensitivity C-reactive protein, and vitamin D. Contrast-enhanced coronary CT angiography was performed.
Significant coronary stenosis was detected in 52 of 385 participants (13.5%). The prevalences were 12% and 30% in those with low risk and with middle-high risk Framingham score, respectively. In those with low risk scores, the prevalences of significant stenosis were 10% and 18% in those without and with vitamin D deficiency, defined as serum 25-(OH) vitamin D< 10 ng/mL (p=0.08). Multiple logistic regression analysis revealed that vitamin D deficiency (adjusted OR=2.18, 95% CI: 1.07-4.43) is independently associated with the presence of significant coronary stenosis after controlling for traditional risk factors.
The study indicates that the prevalence of significant coronary stenoses is high in asymptomatic young and middle-aged African American chronic cocaine users. These findings emphasize the importance of aggressive reduction of risk factors, including vitamin D deficiency in this population.
慢性可卡因使用可能导致早发性动脉粥样硬化，然而，无症状可卡因使用者的冠心病患病率和相关危险因素尚未报道。
2007 年 8 月至 2010 年 6 月，连续纳入 385 名年龄在 25 至 54 岁的非裔美国慢性可卡因使用者，以研究 CT 血管造影定义的显著（≥50%）冠状动脉狭窄的患病率和相关危险因素。通过访谈获得社会人口统计学、药物使用行为、病史和药物数据，并通过病历审查进行确认。进行了临床检查以及广泛的实验室检查，包括空腹血脂谱、HIV、高敏 C 反应蛋白和维生素 D。进行了对比增强冠状动脉 CT 血管造影。
在 385 名参与者中，有 52 名（13.5%）检测到显著的冠状动脉狭窄。低危和中高危 Framingham 评分者的患病率分别为 12%和 30%。在低危评分者中，无维生素 D 缺乏和维生素 D 缺乏者（定义为血清 25-（OH）维生素 D<10ng/ml）的显著狭窄患病率分别为 10%和 18%（p=0.08）。多因素逻辑回归分析显示，维生素 D 缺乏（调整 OR=2.18，95%CI：1.07-4.43）是在控制传统危险因素后，与显著冠状动脉狭窄存在相关的独立因素。
该研究表明，无症状的年轻和中年非裔美国慢性可卡因使用者中显著冠状动脉狭窄的患病率较高。这些发现强调了在该人群中积极降低包括维生素 D 缺乏在内的危险因素的重要性。
