Recent Cocaine Use Quadruples Stroke Risk

SAN DIEGO—Cocaine use within the past 24 hours was reported by 2.4% of 1,101 patients ages 15 to 49 who developed ischemic stroke, compared with 0.4% of 1,154 age-matched controls without stroke, according to research presented at the 2014 International Stroke Conference.

The recent cocaine use was associated with a fourfold increase in the odds of ischemic stroke after adjustment for the effects of age, current smoking status, sex, and ethnicity. The difference in cocaine use between groups and the increased risk with cocaine were statistically significant, Yu-Ching Cheng, PhD, reported.

Females seemed to have a higher risk from recent cocaine use, with an adjusted odds ratio for ischemic stroke of 11 in those who had used cocaine within the previous 24 hours, compared with controls. Males had an odds ratio of 2 for ischemic stroke after recent cocaine use, compared with controls.

“With few exceptions, we believe every young stroke patient should be screened for drug abuse at the time of hospital admission, especially in the case in which there’s no clear etiology” for the stroke, she said in an interview. Knowing about acute cocaine use probably would not change management of the stroke, but it might help to optimize recovery if the patient is encouraged to seek drug abuse counseling, which also may help prevent secondary strokes from continued cocaine use, she added.

Other factors increased the risk of stroke in the case–control study, but none did as much as cocaine use within the past 24 hours. Diabetes was significantly more common in the stroke patients (17%), compared with controls (5%), and was associated with approximately 3.5-fold higher odds for stroke after adjustment for confounding factors. Stroke patients were significantly more likely than controls to have hypertension (42% vs 18%, respectively), which was associated with a threefold greater likelihood of stroke. Significantly more stroke patients were current smokers (45% vs 29%, respectively), which doubled the likelihood of stroke, reported Dr. Cheng, Assistant Professor of Medicine at the University of Maryland School of Medicine in Baltimore.

The Stroke Prevention in Young Adults Study was a population-based, case–control study of people in the Baltimore–Washington area, ages 15 to 49, who either had a first ischemic stroke between 1992 and 2008 or were age-matched controls without stroke who were contacted by random-digit dialing. The investigators collected data through a standardized interview.

The stroke risk from recent cocaine use did not differ by race, with an adjusted odds ratio of nearly 5 for both blacks and whites after cocaine use in the previous 24 hours, said Dr. Cheng. Ever having used cocaine or having used cocaine in the last one to 30 days was not significantly associated with an increased risk for stroke. Males comprised 53% of the stroke patients and 46% of controls.

Approximately 1.9 million US residents have used cocaine in the past month, previous data have suggested, with adults ages 18 to 25 most likely to use cocaine, Dr. Cheng said.

—Sherry Boschert