Cocaine Use and Risk of Ischemic Stroke in Young Adults

Abstract

Background and purpose Although case reports have long identified a temporal association between cocaine use and ischemic stroke, few epidemiological studies have examined the association of cocaine use with ischemic stroke in young adults, by timing, route and frequency of use. Methods A population-based case-control study design with 1,090 cases and 1,154 controls was used to investigate the relationship of cocaine use and young-onset ischemic stroke. Stroke cases were between the ages of 15 and 49. Logistic regression analysis was used to evaluate the association between cocaine use and ischemic stroke with and without adjustment for potential confounders. Results Ever use of cocaine was not associated with stroke with 28% of cases and 26% of controls reporting ever use. In contrast, acute cocaine use in the prior 24 hours was strongly associated with increased risk of stroke (age-sex-race adjusted OR = 6.4, 95% CI=2.2 - 18.6). Among acute users, the smoking route had an adjusted odds ratio of 7.9 (95% CI=1.8 – 35.0), while the inhalation route had an adjusted odds ratio of 3.5 (95% CI=0.7 – 16.9). After additional adjustment for current alcohol, smoking use and hypertension, the odds ratio for acute cocaine use by any route was 5.7 (95% CI =1.7, 19.7). Of the 26 patients with cocaine use within 24 hours of their stroke, 14 reported use within 6 hours of their event. Conclusion Our data are consistent with a causal association between acute cocaine use and risk of early-onset ischemic stroke.

Cracking the Role of Cocaine in Stroke

“…1 Although the majority was using marijuana, past month cocaine intake was still reported by 1.5% of the US population. 1 A similarly high use of cocaine was also found in a population-based case-control study by Cheng et al 2 reporting, in this issue of Stroke, on the association of cocaine exposure and risk of ischemic stroke, from "The Stroke Prevention in Young Adults Study." In their study population, derived from the greater Baltimore/Washington DC area, a quarter of subjects with recent ischemic stroke (cases), between the 15 and 49 years of age, were found to have previously used cocaine.…”

Subarachnoid and intracerebral hemorrhage in cocaine abusers

“…Young age for stroke onset are between 20ies and 50ies, as it was in our case with examinees between 23 and 56 years old 16 . According to the literature data, arterial hypertension is the main reason for hemorrhagic stroke 17 . Indirect sympathomimetic effect of cocaine temporarily increases systolic arterial blood pressure, that can cause spontaneous bleeding from existing arteriovenous malformations, aneurysms, parts of brain previously affected by stroke or can cause new aneurysm 18 .…”

Risk Factors for Recurrent Arterial Ischemic Stroke in Children and Young Adults

“…One of the most commonly abused drugs in the USA is cocaine. In a study by Cheng et al [81], a significant association between acute cocaine use and the risk of AIS in young adults was demonstrated after adjusting for smoking, alcohol consumption, and hypertension (OR = 5.7). As cocaine may increase the risk of AIS, the discontinuation of its use may prevent recurrent stroke [82].…”