Abstract 18163: Cardiovascular Impact of Cocaine in Regular Asymptomatic Users Assessed By Cardiovascular Magnetic Resonance Imaging

Abstract

We hypothesised that significant cocaine-related cardiovascular abnormalities would be present in regular social cocaine users who are otherwise healthy, and detectable using cardiovascular magnetic resonance (CMR).

Methods/Results: 20 regular cocaine users and 20 non-users enrolled. Both groups were similar in age, gender and self-reported history of dyslipidaemia, diabetes and hypertension. Cocaine users had a higher body surface area (BSA), and were more likely to smoke, drink alcohol and take other recreational drugs. Cocaine users had higher systolic blood pressure (SBP) compared to non-users (134mmHg vs 126mmHg, p=0.036), independent of age, BSA and smoking. Cocaine use was the most significant predictor of SBP in regression analyses (β=-0.332, p=0.036). No significant difference existed between the groups for diastolic blood pressure or heart rate. Cocaine use compared with non-users was associated with reduced compliance (1.33 vs 1.69 mm2/mmHg, p=0.004) and distensibility (3.76 vs 5.08 mmHg-1x10-3, p=0.001) of the proximal descending aorta, and increased stiffness index (2.62 vs 2.07, p=0.005) and pulse wave velocity (16.66 vs 14.42 m.s-1, p=0.001). Cocaine use and age, were the significant predictors of aortic stiffness. Cocaine users had an 18% greater left ventricular mass (LVM) than control subjects (p=0.007), a difference that remained significant after indexing for BSA (p=0.038). Cocaine use was the most significant predictor of LVM, independent of BSA and other covariates (β=-0.377, p=0.016). CMR diastolic function parameters: left atrial size was significantly larger in the user group compared to non-users (3.8cm vs 3.5cm, p=0.041), however the difference was not significant when indexed for BSA. Neither left ventricular peak filling rate nor time to peak filling rate differed between the groups. There was no evidence of silent myocardial infarction (MI) as determined by late gadolinium enhancement or segmental wall motion abnormalities in any of the study participants.

Conclusion: Regular cocaine use in otherwise healthy subjects is associated with increased SBP and aortic vascular stiffness, a significantly greater LVM independent of BSA or BP, and no evidence of previous MI.