Qureshi Adnan I, Chaudhry Saqib A, Suri M Fareed K
Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.
J Vasc Interv Neurol. 2014 May;7(1):76-82.
Numerous case series have implicated cocaine use as a cause of both myocardial infarction (MI) and stroke on the basis of the temporal relationship between drug use and event onset. The relatively high prevalence of cocaine use in the US population, especially in younger individuals, mandates a more extensive investigation of this relationship.
We determined the relationship between cocaine use and cardiovascular and all-cause mortality in a nationally representative sample of 9013 US adults aged 18 to 45 years who participated in the Third National Health and Nutrition Examination Survey Mortality Follow-up Study using Cox proportional hazards analyses. We categorized the participants as nonusers if they responded to the lifetime cocaine use question as never used, as infrequent users if they responded as using <10 times, and as frequent or regular users if they reported using 10-99 times or >100 times, respectively. Potential confounding factors in the association between cocaine use and death (cardiovascular and all cause) included age, sex, race/ethnicity, cigarette smoking, hypertension, diabetes mellitus, hyperlipidemia, educational attainment, body mass index, and insurance status. To estimate the impact of cocaine use on MI or stroke, we calculated the population attributable risk (PAR) percent for cocaine use with cardiovascular and all-cause mortality. We also estimated the years of life lost and total annual financial cost due to premature deaths in persons who reported regular use of cocaine.
A total of 60 cardiovascular deaths and 384 all causes deaths were reported during a mean follow-up period of 14.7 ± 2.6 years. After adjusting for differences in potential confounders, persons who reported regular lifetime cocaine use had a significantly higher likelihood of all-cause mortality (relative risk [RR], 1.9; 95% confidence interval [CI], 1.2-3.0 for ≥100 times in lifetime) but not cardiovascular mortality (RR, 0.6; 95% CI, 0.1-4.7 for ≥100 times in lifetime). The PAR of regular cocaine use for all cause mortality among was 1.79%. The years of life lost due to regular cocaine use was 10.3 years for an adult aged 31 years. The overall yearly cost incurred due to premature deaths related to regular cocaine use was $1.1 billion.
Regular cocaine use was associated with an increased risk of all cause mortality but this effect was not mediated through cardiovascular events. Behavior modification by public awareness and education may reduce the mortality and financial burden associated with cocaine use.
众多病例系列研究基于药物使用与事件发作之间的时间关系，认为使用可卡因是心肌梗死（MI）和中风的病因。在美国人群中，尤其是在年轻人中，可卡因使用的相对高流行率要求对这种关系进行更广泛的调查。
我们在9013名年龄在18至45岁的美国成年人的全国代表性样本中，使用Cox比例风险分析确定了可卡因使用与心血管疾病及全因死亡率之间的关系。这些成年人参与了第三次全国健康和营养检查调查死亡率随访研究。如果参与者对终生使用可卡因问题的回答是从未使用过，我们将其分类为非使用者；如果回答是使用次数小于10次，分类为不频繁使用者；如果报告使用次数为10 - 99次或大于100次，则分别分类为频繁或经常使用者。可卡因使用与死亡（心血管疾病和全因）之间关联中的潜在混杂因素包括年龄、性别、种族/族裔、吸烟、高血压、糖尿病、高脂血症、教育程度、体重指数和保险状况。为了估计可卡因使用对心肌梗死或中风的影响，我们计算了可卡因使用导致心血管疾病和全因死亡率的人群归因风险（PAR）百分比。我们还估计了报告经常使用可卡因的人群因过早死亡而损失的生命年数和每年的总财务成本。
在平均随访期14.7±2.6年期间，共报告了60例心血管疾病死亡和384例全因死亡。在调整潜在混杂因素的差异后，报告终生经常使用可卡因的人全因死亡率显著更高（相对风险[RR]，1.9；95%置信区间[CI]，终生使用≥100次时为1.2 - 3.0），但心血管疾病死亡率并非如此（RR，0.6；95% CI，终生使用≥100次时为0.1 - 4.7）。经常使用可卡因导致全因死亡率的PAR为1.79%。对于一名31岁的成年人，因经常使用可卡因而损失的生命年数为10.3年。因经常使用可卡因导致过早死亡而产生的总体年度成本为11亿美元。
经常使用可卡因与全因死亡率风险增加有关，但这种影响并非通过心血管事件介导。通过公众意识和教育进行行为改变可能会降低与可卡因使用相关的死亡率和财务负担。
