Lai Hong, Stitzer Maxine, Treisman Glenn, Moore Richard, Brinker Jeffrey, Gerstenblith Gary, Kickler Thomas S, Li Ji, Chen Shaoguang, Fishman Elliot, Lai Shenghan
From the Department of Radiology and Radiological Science (HL, EL, SL), Department of Psychiatry (MS, GT, SL), Department of Medicine (RM, JB, GG, SL), and Department of Pathology (TSK, JL, SC, SL), Johns Hopkins School of Medicine, Baltimore, MD.
J Addict Med. 2015 Jul-Aug;9(4):331-9. doi: 10.1097/ADM.0000000000000140.
Clinical and epidemiological evidence suggests that cocaine use is associated with an increased risk of premature atherosclerosis. The objectives of this study were to explore (1) whether cocaine abstinence is associated with a reduced marker of endothelial dysfunction, (2) whether cocaine abstinence is associated with a slower coronary plaque progression, and (3) whether reduction in cocaine use is associated with a reduced marker of endothelial dysfunction in African American chronic cocaine users with contrast-enhanced coronary CT angiography-confirmed less than 50% coronary stenosis.
Between March and June 2014, a total of 57 African American cocaine users with contrast-enhanced CT angiography-confirmed less than 50% coronary stenosis in Baltimore, Maryland, were enrolled in a 6-month follow-up study to investigate whether cocaine abstinence or reduction in cocaine use is associated with decreased endothelin-1 (ET-1) levels and coronary plaque progression at the 6-month follow-up. A voucher-based incentive approach was used to systematically reinforce cocaine abstinence, and urine benzoylecgonine test was implemented to confirm cocaine use.
Among the 57 participants, 44 were HIV-infected. The median of duration of cocaine use was 18 (interquartile range, 7-30) years. According to generalized estimating equation analyses, both cocaine abstinence and reduction in cocaine use in the 6 months were independently associated with decreased ET-1. The incidence of coronary plaque progression was 7.4/100 person-years and 23.1/100 person-years in those who were totally abstinent from cocaine and those who continued to use cocaine, respectively. However, the difference in the incidence between these 2 groups was not significant (exact P = 0.30).
The findings of this study revealed a possible association of cocaine abstinence/reduction with lowered ET levels, which suggests that such changes in cocaine use might be beneficial for preventing endothelial damage. Further studies should be conducted to investigate whether ET-1 could be used as a marker for cocaine abstinence and reduction in cocaine use.
临床和流行病学证据表明，使用可卡因会增加过早发生动脉粥样硬化的风险。本研究的目的是探讨：（1）戒除可卡因是否与内皮功能障碍标志物的降低相关；（2）戒除可卡因是否与冠状动脉斑块进展减缓相关；（3）在经对比增强冠状动脉CT血管造影证实冠状动脉狭窄小于50%的非裔美国慢性可卡因使用者中，减少可卡因使用量是否与内皮功能障碍标志物的降低相关。
2014年3月至6月期间，在马里兰州巴尔的摩市，共有57名经对比增强CT血管造影证实冠状动脉狭窄小于50%的非裔美国可卡因使用者参加了一项为期6个月的随访研究，以调查戒除可卡因或减少可卡因使用量是否与6个月随访时内皮素-1（ET-1）水平降低及冠状动脉斑块进展相关。采用基于代金券的激励方法系统强化可卡因戒除，并通过尿液苯甲酰爱康宁检测来确认可卡因使用情况。
57名参与者中，44人感染了艾滋病毒。可卡因使用的中位时长为18年（四分位间距为7 - 30年）。根据广义估计方程分析，6个月内戒除可卡因和减少可卡因使用量均与ET-1降低独立相关。完全戒除可卡因者和继续使用可卡因者的冠状动脉斑块进展发生率分别为7.4/100人年和23.1/100人年。然而，这两组之间的发生率差异不显著（精确P = 0.30）。
本研究结果揭示了戒除/减少可卡因使用量与降低ET水平之间可能存在关联，这表明可卡因使用的这种变化可能有助于预防内皮损伤。应开展进一步研究以调查ET-1是否可作为戒除可卡因和减少可卡因使用量的标志物。
