Cocaine and the Long-Term Risk of Cardiovascular Disease in Women |
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| Affiliation: | 1. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada;2. Institut national de santé publique du Québec, Montreal, Quebec, Canada;3. Division of Cardiology, Department of Medicine, University of Montreal Hospital Centre, Quebec, Canada;4. University of Montreal Hospital Research Centre, Quebec, Canada;5. Department of Psychiatry, McGill University, Montreal, Quebec, Canada;6. Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Quebec, Canada;1. University of Arizona College of Medicine, Tucson;3. Mayo Clinic, Rochester, Minn;4. Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand;5. Aarhus University Hospital, Denmark;1. Walter Reed National Military Medical Center, Department of Medicine, Bethesda, Md;2. Uniformed Services University of the Health Sciences, Bethesda, Md;1. Acute Geriatric Unit, Dijon University Hospital, Dijon, France;2. Acute Geriatric Unit, La Réunion University Hospital, Saint Pierre, La Réunion, France;3. Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), University of Burgundy, Dijon, France;1. Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Conn;2. Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY;3. Department of Surgery, New York University School of Medicine, New York, NY;4. Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY;1. Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md;2. Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Mich;3. Division of Nephrology and Hypertension, MedStar Georgetown University Hospital, Washington, DC;4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md;5. Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Md;6. Nephrology Center of Maryland, Baltimore;7. Division of Nephrology, Department of Medicine, University of California, San Francisco |
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| Abstract: | BackgroundCocaine is associated with acute cardiovascular complications, but the long-term cardiovascular risks of cocaine use are poorly understood. We examined the association between cocaine use disorders and long-term cardiovascular morbidity in women.MethodsWe analyzed a longitudinal cohort of 1,296,463 women in Quebec, Canada between 1989 and 2020. The exposure included cocaine use disorders prior to or during pregnancy. The outcome was cardiovascular hospitalization up to 31 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of cocaine use disorders with cardiovascular hospitalization.ResultsThe cohort included 2954 women with cocaine use disorders. Compared with women without an identified cocaine disorder, women with cocaine use disorders had 1.55 times greater risk of future cardiovascular hospitalization during 3 decades of follow-up (95% CI, 1.37-1.75). Cocaine use disorders were strongly associated with inflammatory heart disease (HR 4.82; 95% CI, 2.97-7.83), cardiac arrest (HR 2.93; 95% CI, 1.46-5.88), valve disease (HR 3.09; 95% CI, 2.11-4.51), and arterial embolism (HR 2.22; 95% CI, 1.19-4.14). The association between cocaine use disorder and cardiovascular hospitalization was most marked after 5 to 10 years of follow-up (HR 2.15; 95% CI, 1.70-2.72).ConclusionsWomen with cocaine use disorders have a high risk of cardiovascular hospitalization up to 3 decades later. Substance use reduction and cardiovascular risk surveillance may help reduce the burden of cardiovascular disease in women with cocaine use disorders. |
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